Commentary by Issam Makhoul , MD
Let ’ s Bring Fred to the Discussion Table
The patient is anxiously waiting to meet
his doctor to ask her about the vaccine and its risk to his health . The cancer that is ravaging his body has been forgotten and the side effects from chemotherapy are now “ less important .” He is determined not to take the vaccine . He follows his circle of friends on Facebook , and he believes that the vaccine will “ kill him .”
In the past , doctors used to be the source of truth about health and disease . They would convey their message to the patients directly or to the masses through official and responsible outlets such as the press , radio , or television . With the advent of the internet and the ubiquitous access to it , classical outlets of information dissemination have lost much of their influence . Everyone has access to the internet now , and that access has exponentially grown to hundreds , thousands , or millions of individuals , if not more . Through this free and unfettered access , many voiceless people have found a voice for themselves and a new power . Further , anonymity liberates people from feeling shame and makes it easier for many to speak and react without consideration for others , often sparing the facts or the truth . It is in this novel context that humanity has had to face the pandemic .
In the long-term , rebuilding our relationships with our with our patients based on patient-centered and value-based-care principles will allow us to regain their trust .
On the internet , the sources of the information about COVID-19 have been , in many cases , anonymous and invariably inaccurate ; yet , despite scientific evidence to the contrary , people believe it . Why ? Humans react to the unknown by seeking knowledge from any available sources , even if the information is egregiously wrong . Large groups of the population have grown more skeptical of the official information channels in our society , what is called “ the establishment ;” they have turned toward sources that amplified these feelings and provided them with an alternative reading of reality that mirrored a politically divided country . News deserts have created a vacuum that allowed this narrative to take hold . While the virus was raging in the bodies , the false narratives about it were spreading , unchecked , in the minds . Indeed , it was a veritable disinformation jungle .
The novelty of the virus made it so easy to spread in a population with no prior immunity to it . Collectively , we knew little about COVID-19 ; however , as our true knowledge was growing , the false information was growing , too , and replacing any true knowledge at the speed of light . Our “ cognitive immunity ” has suffered tremendously over the years . The patient-physician relationship has lost depth and quality ; and we doctors , have let it slip away from us . Its commercialization emptied it from trust , the most important element in positive human interactions . Trust is the factor that allows a group of individuals to believe that the message delivered to them is accurate and trustworthy . But this is not all . Why would a group of our population believe certain ideas even though they are clearly inaccurate ? What happened to the critical thinking of a nation that prides itself on embracing science and using it as a foundation for progress ? Here again , the answer to this question is trust . Many people felt left out by a system that promised them access to the American dream but has not delivered and further , has told them that they were wrong . So , they turned away from that system and became ready to “ trust ” any sources that validated their feelings . As humans , we hold our feelings as belongings , furthering an unwavering transference from scientific rigor and fact . Once these alternate channels have gained their trust , they embraced any narrative coming from them . This is certainly a bigger problem than physicians can address in their exam rooms .
Physicians still have a great chance to reverse the tide , but they need help . In the short term , the success of the vaccination campaign and the control of the pandemic , here and abroad , is likely to bring an end to the misleading and inaccurate information . Hence , every one of us should be a good ambassador for the vaccination of as many people as possible within the shortest period of time possible . In the long-term , rebuilding our relationships with our patients based on patient-centered and valuebased-care principles will allow us to regain their trust . First , reestablishing the sacred bond that transcends monetization and acknowledges the importance and uniqueness of each one of them will open a new door to honest dialogue . Second , allowing patients to bring their unusual ideas , and what they have learned from other sources , to their discussions with their physicians is part of the educational work that we need to do with them . Commonly , I say to my patients , “ Let ’ s bring your Facebook friend , Fred , to the discussion .” After laughter , they feel allowed to discuss the weirdest ideas with me , and we often end up agreeing on a reasonable plan . Regaining our patients ’ trust is the first step , and this we can do .
Volume 117 • Number 9 March 2021 • 197