Charlie Tan is a medical student at McMaster University
Lawrence Loh is Associate Medical Officer of Health at Peel Public Health
Too often, physicians forget that they might be just one of many sources of health advice that patients access. Behind every physician-patient encounter is a difference in how health and wellness are perceived and pursued. For many physicians, their views and advice are shaped by formal education and training, the Hippocratic Oath, and the insights of colleagues, researchers, and experts. Their patients, by contrast, have a different and often wider range of influences, be it personal beliefs, social networks, or cultural traditions.
Over the last three decades, physician practice has been transformed by two important movements: evidence-based medicine and the patient-centred care movement. These paradigms are ideally synergistic. In providing care, physicians engage their patients in a partnership, incorporating evidence individualized to patients’ unique circumstances and presented in a format they can understand.
Inviting patients to be active participants in their health has been shown to have a plethora of benefits, including better outcomes and greater treatment adherence. However, the empowerment of patients has also increased the risk of questioning or disagreement on treatment plans and advice. Patients may sometimes adopt behaviours that they feel are best for their situation, but run contrary to the teachings and evidence guiding their physician opinion. Of greater difficulty is when inaccurate information turns patients into proponents of “pseudoscience.” Physicians might be tempted to dismiss these contrary views without exploring the underlying reasons why patients subscribe to them. This in turn limits the ability of physicians to address these unfortunately misplaced beliefs in safeguarding their patients’ health.
Too often, there is a disconnect between the health information received and acted on by doctors and by patients. Much of this stems from increased access to information via the Internet. While the Internet has democratized access to information and free speech, it also presents challenges by giving broader license to fringe views that might not be supported by evidence. From the research being published, what ultimately ends up becoming public depends on search engine optimizations, curated by clicks, newsworthiness and Groupthink. Consequently, a research to awareness gap often results, in which the information the public should receive is not what is communicated.
Other contributing factors to this divide include our culturally diverse populations, the allure of celebrity, and the rise of social media. Certain ethnic groups may perceive and understand illness differently and hold healing traditions in higher esteem than evidence-based biomedical practices. Celebrities and public personalities continue to promote various unfounded health behaviours ranging from diets and cleanses to refusal of childhood vaccinations. One 2009 survey of American parents found that 24% of respondents placed at least “some trust” in vaccine safety information from celebrities. Compounding these elements is the prominence of social media platforms, such as Facebook and Twitter, which have allowed users to become social network influencers by synthesizing and sharing information collected from disparate sources, representing them as personal viewpoints.
It is in this contemporary context that physicians must fulfill the duty of helping patients achieve their best possible health. How can doctors balance sensitivity to patients’ views while advocating for evidence-based practice, particularly in the face of potential harm? How can they simultaneously protect their credibility and preserve rapport with patients?
When presented with views that run contrary to current evidence or guidelines, doctors must resist the urge to immediately discredit them as misinformation, and instead aim to explore. Patients comprehend their health differently than healthcare professionals, and their views may hold personal or cultural meaning; simply dismissing these views risks worsening the therapeutic relationship and reducing patients’ trust in the healthcare establishment. By appreciating what matters to patients and the personal, social, and cultural factors influencing how patients understand their health, physicians can then draw on their medical knowledge and make evidence-based recommendations in a way that is tailored to the patient.
There are also opportunities for physicians to contribute to the broad forces that shape patient perspectives on health. Physicians should incorporate greater cultural awareness into their practice to avoid harmful stereotypes and recognize the role that culture plays in patient health behaviours. An awareness of trending perceptions among the general public would also help physicians discuss key topics effectively, allowing them to challenge harmful practices in a cogent manner and improve rapport. Understanding where patients get their health information from can help also help to identify credible health journalists, academics and online sources, which can act as resources for both physicians and patients.
It falls to physicians to bridge the information gap that exists between them and their patients. While challenging, balancing evidence with patient perspectives is essential to protecting patient engagement and promoting more patient-appropriate medical decisions. It will require physicians to hone their skills in empathy and expand their view of medicine beyond journals and guidelines to understand patient-specific, cultural, and societal contexts.