These American Heart Association Scientific Sessions have been a breathtaking representation of the diversity, potential and scientific progression of the greater cardiovascular diseases community. Among the flashing lights of landmark trials, late-breaking sessions and Cardiology fanfare, a small contingent gathered in room 202AB for a discussion on cardiovascular outcomes and improved quality of care. Titled “Peddling EBM in the Era of Fake News and Dr. Google,” Drs. Raina Merchant, Joseph Hill, Peter Groeneveld, Annabelle Volgman and Shannon Dunlay astutely presented the current landscape of healthcare delivery and the challenges of mending a broken doctor-patient relationship in an age of misinformation.
It is well known that an air of mistrust/distrust exists between the US population and the healthcare system. The 2019 Edelman Trust Barometer Report (www.edelman.com) showed that only 61% of Americans trust our healthcare system; a number that places us neck and neck with Turkey, and a far cry from the 83% boasted by India and Indonesia. This is due to a combination of our history of mistreating patients for the sake of scientific discovery, as in the Tuskegee Study of Untreated Syphilis in the Negro Male, as well as the greed of physicians who practice based on compensation rather than compassion. This is has led to a knowledge vacuum, as physician-led education of the population has been replaced by celebrity and influencer-led misinformation.
We have all walked into the room and had a patient expert waiting with pages of print-outs ready to educate you on their disease pathology. Or maybe you’ve walked in and had to convince the skeptic that rat poison will prevent them from having a future stroke. I’ve certainly had to talk a number of cyberchondriacs off of the ledge, as their Google search of “headache” resulted in a diagnosis of terminal cancer. We fail when we neglect the social, cultural and religious contexts within which our patients operate. The approach is the same for all three of the aforementioned personalities: 1) listen more than speak 2) validate their concerns 3) develop partnership/goals 4) make a recommendation.
Physicians are not inherently great at persuasion. We tend to believe that our patients (and friends/spouses/etc) think logically, and approach them as such. Aristotle used three terms to describe how persuasion or rhetoric works. Ethos or the ethical appeal, means to convince an audience of your credibility or character. Pathos or the emotional appeal, means to persuade an audience by appealing to their emotions. Logos or the appeal to logic, means to convince an audience by use of logic or reason. When your patient walks into the office, convincing them that you’re the one ethical doctor in town isn’t going to work, neither is describing the all cause mortality benefit of their new prescription.
The key to building and rebuilding this broken relationship, as well as combatting misinformation, is to appeal to the emotions (or pathos) of our patients. We must always remember that patients ultimately have 3 questions for us: do you know what you’re doing? Will you tell me what you’re doing? And are you doing it to help me, or to help yourself?1 If the answers to those questions are increasingly “yes, yes and yes” then we can look forward to a future where Medicine is once again regarded as the most noble of professions; and one where we deliver the best quality of care to our patient.
- Dhruv Khullar, MD, MPP. Do You Trust the Medical Profession? NY Times. Jan 23, 2018.
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