142. Wash Your Hands!: Discerning Facts from the Preposterous vs. Plausible (CE)

In this first of three podcasts on medical misinformation titled, "Wash Your Hands!: Discerning Facts from the Preposterous vs. Plausible," NP experts Paula Tucker and Ruth Carrico focus on the critical issue of medical misinformation in the United States and its widespread impact. The content aims to help listeners identify medical information they've accepted without credible evidence and apply critical thinking to determine the validity of commonly accepted medical claims. This episode explores the role of biases, health care disparities and social determinants of health in perpetuating misinformation. It emphasizes the importance of asking the right questions, seeking reliable data and recognizing the hallmarks of unfounded health claims. The accompanying educational resource, "A Clinician's Guide to Medical Misinformation – Part 1: Discernment," provides a comprehensive review of misinformation hallmarks, common tactics and real-world clinical scenarios to help health care professionals and patients navigate the complex landscape of health information.

Learning Objectives:

1. Identify at least one piece of medical information you have accepted without credible evidence of validity.
2. Apply critical thinking to determine the validity of commonly accepted medical information.

To claim 1.0 contact hours (CH) of continuing education (CE) credit for this program, "Wash Your Hands! Discerning Facts from the Preposterous vs. Plausible," click here to go to the AANP CE Center and complete the post-test and evaluation by entering the participation code provided after listening to the podcast.

Download the clinical resource here.

This podcast and resource tool were supported by an independent medical education grant from Kenvue. 

Episode Transcript

(00:13):
- Welcome
to this edition of NP Pulse, the voice
of the nurse practitioner.
I'm Cammie Hauser, a nursepractitioner, nurse midwife,
and AANP education
specialist.
This podcast
brought to you by theAmerican Association

(00:33):
of Nurse Practitioners featuresnurse practitioner voices
and expertise on issuesthat matter most to NPs
and to our patients.
In this first of three podcastson medical misinformation,
Paula Tucker and Ruth Carricodiscuss the challenges nurse
practitioners face inhelping patients navigate the

(00:53):
increasing amount of healthinformation available.
They address the complexitiesof sharing medical information
with patients and working to find pathways
to address current and futurehealth issues and concerns.
The discussion todaycovers several key points,
the challenge of helpingpatients navigate the growing
volume of health information, the impact

(01:15):
of misinformation onpatient decision making,
the various sources of medicalinformation, both credible
and potentially unreliable.
The concept of misinformationand its broader implications
and the potential for misunderstanding
or misinterpretation ofcredible information.
Paula and Ruth aimedto peel away the layers

(01:36):
of this complex issue,exploring current medical myths
and ways to help patients make sense
of information available. Welcome,
Paula and Ruth.
Welcome everyone to the AANPpodcast series on medical
myths.
I'm delighted to have the opportunityto welcome you to the first of a

(01:57):
three-part series.
This first podcast isentitled Wash Your Hands,
Discerning Facts from the Preposterousversus the Plausible. Now,
we're not going to talkspecifically about handwashing,
but instead we're going to betalking about medical information.
Our learning objectives are first,

(02:17):
identify at least one piece of medicalinformation you have accepted without
credible evidence of validity.
And the second is apply criticalthinking to determine the validity
of commonly accepted medical information.
So I'm so delighted to be with youtoday. My name is Dr. Ruth Carrico.

(02:38):
I'm a family nurse practitionerbased in Louisville,
Kentucky and also adjunctfaculty with the University of
Louisville's Division of InfectiousDiseases in the School of Medicine.
I am so happy to be joined by mycolleague, Dr. Paula Tucker. Paula,
can you tell us a littlebit about yourself?
Absolutely. Welcomeeveryone. My name is Dr.

(03:00):
Paula Tucker and I am anemergency nurse practitioner.
I currently reside in Atlanta, Georgia,
where I have an active practiceat our level one trauma center.
And I also carry the role of an associateprofessor and specialty director
for the Emory University Nell HodgsonWoodruff School of Nursing Emergency
Nurse Practitioner Program. I'm sodelighted to join my colleague, Dr.

(03:24):
Ruth Carrico and excited aboutengaging in this amazing
conversation.
Well, both Paula and I thankyou for joining us today.
So as nurse practitioners,
we all know we are well versed and reallyused to sharing information with our
patients and in fact,
we know that they trust us toprovide them with information that

(03:46):
is accurate, complete, and credible.
Our challenge is trying to findways to address the patient's
current and their future healthissues and concerns and recognize
them as individuals. Now,
helping patients navigate the everincreasing amount of health information is
truly one of our current challenges,and you literally cannot turn on the tv,

(04:10):
the radio, or look at your cellphone without seeing that in action.
Now this is complicated by the problemswith some of the information that our
patients may use to makeimportant and sometimes critical
decisions, and these decisionsmay impact their healthcare,
but also it may impact thehealthcare of those for whom they are

(04:32):
responsible,
maybe their children or maybe they’re even a caregiver for another individual
in the family. So duringour time together,
Paula and I will spend some of thistime talking about just a few examples
of some of the current medicalmyths and then try to offer some
examples and some insight intosome of the ways we can help our

(04:55):
patients try to make sense of thisavailable information as they are
trying to wade through fact and fiction.
This is a journey that we willtry to walk together. So Paula,
are you ready to get started with me?
Absolutely, Ruth.
Very good. Well,
first let me start by talkingbriefly about medical misinformation.

(05:17):
Now, there are many avenues forus to access medical information,
including sources that we personallyconsider to be credible or
sources that we have used,
but also we are increasinglyinformed and knowledgeable
about sources whereinformation is incorrect.
And it may be that the informationis incorrect simply because someone

(05:41):
has misinterpreted, they don't understand,
or they have made some assumptions thatare not true and then they've begun to
build their own story. Butwe know also unfortunately,
that some people enjoymischief and they will post
information to be purposefully misleading.
So our challenge is sometimestrying to figure out where is this

(06:05):
information?
But I think that we've alllearned that trying to explain
misinformation takes us down a rabbithole
that we sometimes cannot climb out of.
So really talking with ourpatients about the information
itself,
focusing on the validity of theinformation and then trying to walk that

(06:26):
journey with the patient and give themaccurate information to the best of our
ability, but also being truthful,
being transparent when there are areasof information where perhaps the science
isn't there or where theinformation is so complicated or
complex that it takesmore time and more depth,

(06:47):
more energy,
more knowledge to actually get to a placewhere the patient can understand it.
So that can be time consuming.
It may not even be somethingthat we can do all at one time,
but it is certainly a journey that weneed to get started on because remember,
at the end of the day, we arenot a parent to our patient.

(07:09):
We are a partner to our patient. Andthat means we walk this journey together.
So when we talk with our patientsabout medical issues of any kind,
we recognize the challengesthat they have as individuals.
And I'm really going to beinterested to hear Paula,
when you are talking about someof these issues that make people,
the people they are and how we need tobetter understand them as we get more

(07:33):
into our time together.
So we're going to try to peel awaya number of the layers of this very
complicated and complex issue.
So lemme start with an example.
This is a health discussion that almostall of us have had probably by
saying almost that's reallynot comprehensive enough.
It is likely to be something thatall of us have had at one point,

(07:55):
and that is talking with ourpatients about vaccination. Now,
we're not going to focus on vaccinationexclusively today by any means because
I think if you're like me,
I've got a certain amount of fatigue nowwith this that I've talked about this
so much.
But we really want to talk about theimportance of medical information in a
number of topics where we canreally see that if we have a

(08:18):
framework for the discussion,
if we develop a methodologythat helps us then to use that
consistently and become moreadept at having the conversations
that our patients will need.
So we know our patients bringmany different questions to us.
And if I go back to thenotion of vaccines that

(08:39):
my patients have come to me with avariety of questions and comments
regarding their fears, their concerns,
and that I consider to bea tribute to the trust that
patients have in me,
that they will bring thensome reasons for fears or
concerns that would before covidand before I begin to hear all this,

(09:02):
it would really make mescratch my head. And I'm like,
how in the world do you thinkthat or why do you think that?
But the fact that that's the patient'sstarting point becomes then the point
of our initiation of conversationand acknowledging the
fact that they have these concerns.
I'm not judging whether ornot I agree with them or not,
but I start off by acknowledging thatthis is my patient's starting point.

(09:25):
So this is where we begin.
So if they tell me I've read on Facebookthat the flu vaccine doesn't work,
for example, how do we respond? Well,
we certainly use ourbackground in understanding
virology and pathophysiology.
We acknowledge their concern and thenwe start talking about where we received

(09:47):
our information. We acknowledge thentheir concerns about the vaccine,
what we have learned about how vaccineswork. So for example, with flu vaccine,
we tell them that this isa short incubation period.
We want to make sure you've got vaccinesso that you have the production of
circulating antibodies so your immunesystem soldiers are right there in the

(10:09):
event exposure occurs, and then wecan make it very personal to them.
So whether we focus on healthissues for them or we do like
I wish I had a nickel for everytime my patient said, well,
what would you do, that allows me theopportunity to bring in some personal
stories and then make thisthen a discussion all about

(10:30):
them.
So I'm going to spend less time talkingabout the esoteric or something that
belongs to someone else,a health issue or data.
I want to make it about thepatient. And at the end of the day,
whatever we talk about,
I'm trying to inform themso they then are able to
make the best choice for themwhen they make that best choice.

(10:53):
My job is to make sure that they'remaking that choice based upon reality and
the best information, atleast the best as I know it.
And then I support thepatient's decision. Now,
many times when I have a discussion witha patient about the health issue and we
are really struggling to find thatcommon place to talk about something that
is concerning to them,

(11:15):
I'll realize that I may not be able toget the patient across what I consider to
be the finish line at that one visit.
And so I'll let 'em know that just likeI'm going to ask you every time I see
you, I'm going to ask you aboutthe medication that you're on.
We're going to be doing medicationreconciliation if you smoke,
I'm going to be asking and talkingwith you about smoking cessation.
I'm also going to be talking aboutvaccines and vaccination so the patient

(11:39):
understands the context inwhich I will be bringing up then
a piece of health information ora question about where they are.
But again, it all starts with how amI going to have this thought process?
How do I need to be creative?
What is the level of criticalthinking that I need to have

(12:00):
at my fingertips? So Paula,
I want to see if I can thenget some insight from you.
You have in our prior discussions,
had some excellent examples of how toapply critical thinking in order to
determine the validity, how true isthe information that I'm going to use?
And I know that I've commonly acceptedsome information maybe without

(12:25):
going into that level of assessment.
So how can I do a better job in mypractice with critical thinking?
Thank you, Ruth, for setting thestage for today's discussion. Wow,
you've done an excellentjob really highlighting the challenges we face as nurse
practitioners in helping our patientsnavigate what I would believe to be a

(12:47):
very overwhelming amount of healthinformation that is available
today. And as you pointed out,
we are not just dealing withoutright misinformation,
we also must address themisinterpretation and
misunderstanding of crediblemedical information.
And that's where criticalthinking plays a crucial role.

(13:10):
As nurse practitioners,
we often assume that if we just giveour patients the right information,
they'll make the right choices.But we know it's not that simple.
Misinformation isn't justabout facts, it's about trust,
access, education, and social context.

(13:30):
And that brings us to the broaderissue that we must consider,
which is those social determinants ofhealth and the role in shaping what
our patients and how theymake health decisions.
So let's dig deeper into howthese structural factors like
economic stability, educationand medical mistrust,

(13:52):
fuel misinformation, and more importantly,
what we as clinicians cando about it. So all right,
let's start with the quick questionfor the listening audience.
Have you ever believed a piece of medicaladvice without actually checking it
was true. I know I have.
And maybe it was something that wastold to you at a young age. For example,

(14:15):
my grandmother told me to stop crackingmy knuckles because it could give me
arthritis. And I believe thatfor a very long period of time.
Maybe that's not your story,
but what about have you felt right abouta health tip because everyone seemed to
just believe it? If so, don'tworry, you're in good company.
The reality is misinformationis everywhere and we're all

(14:39):
susceptible to it. But the good news,
we can mitigate this and this isthe role of critical thinking.
That's exactly what we're tackling today.
So let's roll up our sleeves andengage in what I call a very crucial
conversation on ways we canpartner with our patients to
address misinformation,

(15:00):
understanding that this conversationis dynamic and certainly
an evolving process.
So I have a few questions that I thinkare important for us as clinicians to
pose now. First things first,
how do we even begin to figure out
what’s evidence-based and what's not? It's simple.

(15:21):
We ask the right questions. In research,
we start with asking a question thatis often developed out of a gap in the
knowledge. So the first question,who is making this claim?
Is it coming from a healthcareprovider, a scientist,
or a reputable health organization?
Or is it coming from someone's uncle onFacebook who got a medical degree from

(15:46):
YouTube University? The second question,
where's the evidence?
Is there a legitimate study backingthis up or is it all based on these
personal stories? I heard it froma friend or just trust me, bro.
You know the logic. Andthen the third question,
is this claim new or hasit been tested over time?

(16:09):
Listen, scientific discoverieshappen all the time,
but has it been internally andexternally validated? The bottom line,
the more sensational the claim, thestronger the evidence should be.
And if it sounds too good tobe true, it probably is. Now,
let's get real for a second.

(16:30):
Misinformation disproportionatelyaffects marginalized groups
not because of inherentdifferences in judgment,
but due to structural inequitiesand access to accurate,
credible health information. You see,
not everyone has the same accessto reliable health information.

(16:50):
In fact, when we talkabout misinformation,
it's essential to recognize that itseffects are not equally distributed
across populations,marginalized communities,
those already facing systemicbarriers to health are
disproportionatelyimpacted by misinformation.

(17:10):
Exacerbating existing disparitiesand creating new challenges for
clinicians, and this was certainlyexposed during COVID-19 pandemic.
I want you to think about this.
If you don't have regularaccess to healthcare,
where are you going to get your medicalinformation? Probably online, right?

(17:31):
And if you don't have a strongbackground in health literacy,
how do you even know whichsources are credible?
So when we talk about misinformation,
we have to acknowledge that not everyoneis starting from the same place.
Some people have to rely on less thanreliable sources because that's all they
have,
and that's where social determinants ofhealth come in as the intersection with

(17:55):
health misinformation.
So I want to talk a bit about thosefive domains of social determinants of
health and provide just a few exampleswhere we could see this intersection at
play with medical misinformation.Let's start with economic
stability.
Patients who are in financialdistress often avoid or delay

(18:16):
healthcare services,
leading them to seek maybe cheaperalternative solutions that may not
be evidence-based. So for example,
a patient without insurance mayrely on social media or unverified
blogs to self-diagnose and treattheir symptoms. For example,
I have a better example.

(18:37):
I recently saw a patient in the emergencydepartment who presented with concerns
for lower extremity edema,
and she exposed to me thatshe purchased diuretics
on Amazon because she didn'thave any health insurance.
And they might purchase thesenatural remedies online or

(18:58):
even go on Amazon thinking they are saferand more affordable than prescription
medication.
So economic instabilitycertainly creates a barrier to
accessing trustworthy health services,
increasing the relianceon misinformation driven
alternatives. Let's talkabout educational access.

(19:19):
Health literacy levels, we'veseen this in multiple studies,
are directly tied to education quality.
Without a foundation inscience or critical thinking,
individuals are more likely to believesimplistic or sensational health
claims.
So consider a patient with limitededucation who hears about a miracle diet

(19:40):
that promises to cure diabetes.
And without the knowledge and toolsto evaluate the evidence critically,
they may follow the advice withoutconsulting their healthcare provider.
So education certainly shapes aperson's ability to critically
analyze health information anddiscern what is fact from fiction.

(20:02):
And let's talk about healthcare access.
Patients with limited access tohealthcare often feel neglected by the
healthcare system if their interactionswith providers are rushed or
dismissive.
This also compounds to theirexperiences and they may lose trust
and turn to non-medicalsources for guidance.

(20:23):
Let's talk about a patient with thehistory of chronic pain and limited access
to a primary care provider mightbecome more skeptical of mainstream
healthcare relying instead onanecdotal advice from online
forums that are promoting highdose CBD oil as a cure all.
So building trust in the healthcaresystem is essential to reducing

(20:46):
reliance on misinformation.
Clinicians must take time to engagewith patients and address their
concerns empathetically.
And then let's talk aboutneighborhood and built environment.
In rural communities, particularlythose healthcare deserts,
individuals might rely on influencersclaiming to offer medical solutions.

(21:08):
These solutions often lackscientific backing and can lead to
delays in seeking appropriate care.So certainly geography matters.
So addressing disparities inhealthcare infrastructure can limit the
spread of misinformation in isolatedcommunities. And then finally,
social and community context.

(21:30):
Cultural norms and social influencesplay a significant role in shaping what
individuals perceive as theirtruth. Trust in certain sources,
particularly family,
community leaders or even onlineinfluencers often outweighs
trust in clinicians. For example,
a patient from a tight-knitcommunity that distrust vaccines

(21:54):
due to historical trauma may rejectthe evidence-based advice and instead
follow the guidance of a localfigure who promotes natural immunity.
Now here's a big one. Iwant to talk about. Trust,
specifically mistrust inhealthcare and how that feeds into
misinformation.

(22:14):
We know that historically marginalizedcommunities have experienced medical
mistreatment.
Remember the Tuskegee syphilisstudy to even unethical
sterilizations. That's real valid trauma.
And when people don't trust the system,
they're way more likely toturn to alternative sources even when those sources

(22:36):
aren't scientifically sound. Sowhat do we do about it? Well,
if we want to stop misinformation,
we can't just say trust us andexpect people to blindly follow,
we have to earn that trust back.
And that means meeting people where theyare addressing their concerns without
dismissing them and being transparentabout what we do and don't

(23:01):
know,
engaging communities and respectingtheir cultural perspective is certainly
key to combating misinformation.
So when we talk about misinformation,
we have to acknowledge that not everyoneis starting from the same place.
A patient with limited resources ora history of medical mistrust might

(23:23):
not have the access to the samecredible information as someone with
economic and social stability.
So our role as clinicians is thatwe meet patients where they are and
understand their contact.
We build trust by validatingtheir experiences and providing
evidence-based information and challengemisinformation without judgment,

(23:46):
using empathy and cultural humility.
So before I turn itback over to you, Ruth,
I want to talk a little bitabout bias and how this fuels
misinformation. And beforeyou say, Nope, not me.
Yes you do. We all do.It's how our brains work.

(24:06):
Bias plays a fundamental role in thespread of medical information and
in shaping how patients and cliniciansinterpret health information.
And let's face it, socialmedia, oh, it loves our biases.
The more we click oncertain kinds of content,
the more the algorithm feeds usmore of it. And before you know it,

(24:28):
you're deep in a rabbithole of miracle cures,
secret government coverups,
all because the system rewardsengagement over accuracy.
So let me discuss cognitivebiases which are mental
shortcuts our brains taketo make quick decisions,
but they can also leadto errors in judgment,

(24:50):
especially in clinical decision-making.
Here are some of the most common cognitivebiases that impact both clinicians and
patients. Let's startwith confirmation bias.
This is the tendency to search for,
interpret and recall informationin a way that confirms our
preexisting beliefs. Sofrom a clinician standpoint,

(25:12):
we may dismiss patient concerns ifthey challenge our understanding of
evidence-based medicine. So for example,
you have a patient that says they'rehesitant to take the flu shot because they
believe it causes theflu. Instead of engaging,
a provider dismissestheir concern outright,
losing an opportunity to educate.

(25:35):
So how do we mitigate this?
What evidence wouldmake me change my mind?
We have to encourage ourpatients to explore alternative
viewpoints and questiontheir sources.
Availability bias.
So this is where we judge the likelihoodof an event based on how easily we're

(25:55):
able to recall examples.
So we might overestimate the likelihoodof a disease if we recently saw a
similar case.
So we as a clinician maydiagnose a patient with viral
gastroenteritis who's presenting withnausea and vomiting because they've
seen many cases recentlywhen in reality it could be

(26:17):
appendicitis.
So we have to be careful not touse the available information
to quickly make those decisions.
And if a patient refuses COVID-19vaccine because they saw one
person on social media claimingit caused heart problems,
ignoring large scale studies showingits safety, we have to address this.

(26:40):
We have to check the data trends.
And instead of relying solelyon recent personal experiences,
we certainly have to make sure that weencourage patients to see the bigger
picture rather than individual stories.
And then we have authority bias.
This is where we tend to trustinformation from authoritative figures,

(27:02):
even if it lacks evidence.
And I know I've been guilty ofthis where I've trusted my senior
colleagues or renowned expertswithout questioning those conclusions,
we check a lot of practices,
particularly those that areoutdated because we've done it so many times without
looking at the newer evidence thatis available. And so as clinicians,

(27:23):
we certainly need to challenge medicaltraditions when we know that new evidence
is available that contradictsthem. And as patients,
we certainly have to encourage them toevaluate the credentials and sources
before accepting health advice.And then there's anchoring bias,
the tendency to rely too heavily onthe first piece of information we hear.

(27:47):
It's that initial diagnosis orfirst impression that we're overly
confident about thatinfluences our decision making.
A patient who presents with fever andthe provider quickly anchors on the idea
of a simple viral infectionoverlooking possible autoimmune
conditions or these atypicalinfections. And so clinicians,

(28:09):
we have to remain flexible andopen to revisiting diagnosis
when new evidence emerges.
This is why we expand ourdifferential diagnosis and constantly
evaluating what evidence isavailable. And for our patients,
we should encourage them toconsult multiple reliable sources

(28:30):
before forming strong opinions.
And then there's another one I want totalk about that we often don't hear a lot
about, but this is theDunning Kruger effect.
This is where people with low knowledgein a subject overestimate their
competence, while experts tendto underestimate their knowledge.
And so you may have a junior providerconfidently prescribing antibiotics for

(28:53):
viral bronchitis without realizingtheir knowledge gaps because they're
overconfident. And then for patients,
those patients with no medical trainingarguing against vaccines on social
media, citing personal researchthat lacks scientific rigor,
that's a problem. Sohow do we mitigate that?
We balance confidence withhumility being open to ongoing

(29:17):
learning. And for patients,
we encourage them to recognize thelimits of their knowledge and trust the
expertise. So biasesaren't inherently bad.
They help us make decisions,but in healthcare,
they can lead to errors in judgment,
poor patient interactions andreinforcement of misinformation.

(29:39):
So let's ask ourselves thosetough questions. Ask clinicians,
are we willing to equitably engagewith patients who disagree with
us or hold a diametric worldview?
When a patient expressesvaccine hesitancy,
do we immediately label them asanti-science or do we take the time to

(30:00):
understand their concerns?
And are we willing to challengeour own biases about patients
based on race, socioeconomicstatus, education level,
or even appearance?
So the key takeaway is that bothclinicians and patients must be willing to
challenge their assumptions,seek high quality evidence,

(30:21):
and engage in conversations with anopen mind. I've said a lot, Ruth,
I'm going to turn it back over to you.Do you have any thoughts about that?
Oh my gosh,
I've learned so much in listening to youand have so many new thoughts that are
in my head.
And I think basically it's a criticalreminder that all patients are not the
same. Therefore,

(30:42):
we have to have a variety ofpathways or approaches that
enable us to not only address concerns,
but also select the rightapproach and pieces of information
that we use to introduce new thoughts,
new approaches to an individual patient.
And it really strikes me that I rememberI've had the in patients that are highly

(31:05):
educated and highly motivated,
and my bias is that I assumethey will already have a level of
knowledge and a level of understanding.
And I may enter a conversationwith them where I don't realize,
or I don't take the time to goto where they are exactly like
you said, I first need to discoverwhere are they in this issue?

(31:28):
And they may have incredibleknowledge about science or the
arts or many different areas of life,
but the area about health may be somethingwhere we've got to spend a little bit
more time. So I need to investigatewhere they are and then be
willing to take a look and self-reflect,

(31:50):
really think about how I'mapproaching and am I biased in
my approach because I make theassumption that they are not
disadvantaged in eitherknowledge or motivation or access
of health information or abilityto accurately interpret what they
have found.

(32:10):
I love the fact that you mentionedhow much we are impacted by
artificial intelligence,
that when we use social mediathat those algorithms will quickly
learn and see where,what are we searching,
how long are we stopping to readand will continue to feed us more
information? And someof that may be accurate,
but some of it may beinaccurate. So our patients,

(32:33):
regardless of their knowledge level,
are going to be constantly bombardedwith something that may challenge
their existing thoughts,their existing knowledge,
or may reinforcemisinformation or inaccuracies.
So this really makes iteven more important that we understand the dynamic or
the fluid nature ofinformation. Not only that,

(32:57):
I think you would also mentionthat even when we have evidence,
it doesn't mean that investigationor new evidence will stop that
we will constantly be learningmore. So as a nurse practitioner,
that means I need to thinkabout my self-development.
So maybe I need to becomewell-versed at reading the medical

(33:19):
literature.
Maybe I need to extend beyond mytypical journals or places where
I go for my information. Ineed to expand my horizon.
I need to be able to betterunderstand new information as
it is coming to me that will thenimpact my practice and my decisions.
So you've made me makemy own to-do list about

(33:43):
how I need to improve my practiceand what do I need to be doing
to improve my abilitiesand expand my knowledge.
We know new health informationis continuously emerging,
but inaccurate interpretation ofinformation or even information that's
designed to purposefullyconfuse or mislead

(34:05):
individuals remains a hurdle,whether it is intentional or not,
people are going to make assumptionsabout what they read and what they hear.
They're going to share information.
It may be information that is justshared at church or across the fence or
whatever.
So it reinforces thenthe importance of us as

(34:27):
nurses using the trust that the patients,
the communities have in usto continuously search for
new ways to share informationand really develop our skills
at establishing connections andconversations with our patients.
So you had talked about just the dynamism,

(34:50):
the fluid nature ofhealth information and the
changing environment,
not only of where patients getinformation, how they get it,
but also how we interpret it andhow we have conversations with our
patients. You had mentioned theimportance of clinician self-reflection,
how I think about what are mystrengths, what are my weaknesses?

(35:13):
How do I view this? What aresome assumptions I'm making?
What are my inherentbiases as you went through
then a number of these biases,
perspectives and paradigms,
and that becomes important for us whenwe are thinking about how do we determine
what is the truth, how do weunderstand and how do we identify it?

(35:34):
So I want to get some moreinformation from you about this
notion of dynamism andchange and how we look at
this in terms of ourinformation, how we digest it,
how do we then share it withpatients and some new approaches.
What more can you tell me about this?

(35:54):
Absolutely. I think it's importantthat we start with a hard truth.
Just because we're clinicians doesn'tmean we're immune to misinformation.
As I mentioned, we all havebiases, and the question is,
are we actively reflecting onthem? You mentioned that again,
that part of reflection.

(36:16):
Are we willing to pauseand question if we are
relying on outdatedresearch, flawed heuristics,
or even personal experience thatconflicts with the evidence,
and are we willing to admit we're wrong?
That is the truth. And that bringsus to this clinical self-reflection.

(36:39):
In healthcare, we talk a lotabout evidence-based practice,
but the truth isn't just aboutdata, it's about context,
it's about reproducibility,
it's about rigorous scientificprocess. And I said a lot there.
As I mentioned to you earlier,social context is huge.

(37:01):
Being able to see if thedata has withstand over time,
that's reproducibility. Is it stillproducing what it was intended to produce?
Is it rigorous? What was the process?
What was the methodologyto get to the outcomes?
That's the scientific process.For example, 20 years ago,

(37:23):
H. Pylori's role in gastriculcers was controversial.
Today it's an indisputable fact. Why?
Because the evidence was repeatedlytested and confirmed across multiple
studies. In contrast, thesemiracle weight loss supplements,
they have often relied onone questionable study,

(37:43):
lack reproducibility, andyet they go viral overnight.
So truth in medicine isn'tabout what's trending,
it's about what withstandsscrutiny over time.
What is the context,how was it reproduced,
what was the process,the scientific process?
And I think we as providershave to begin to seek that

(38:07):
information so that we can sharethat information with our patients.
If misinformation spreads because of bias,
then the first step is combating,
recognizing we all havebiases, clinicians included.
Are we shutting down conversationsbecause we assume we know best?

(38:29):
Are we dismissing our patients'concerns outright rather than exploring
why they hold thesebeliefs? And for patients,
are they willing to accept clinicianrecommendations based on objective data
even if it directly opposestheir current beliefs?
So if a patient believes GLP-1agonists are completely safe for weight

(38:52):
loss, but experiencessevere nausea and vomiting,
will they be open to arisk benefit discussion?
That is something we’re going to haveto be able to have with our patients.
If a patient is vaccinehesitant due to misinformation,
are they open to anevidence-based discussion?

(39:13):
So the bottom line is thatbias is a two way street,
and the goal isn't to win an argument,
it's to create an open space wherepatients feel heard while still being
guided toward an evidence-based decision.
I want to talk about the ageof data because we are in 2025,

(39:34):
and let's be honest,
the days of patients getting all theirmedical information from their doctor are
long gone. We are nowcompeting with TikTok,
AI chatbots, Reddit threads,and these wellness influencers.
And so for those of us who are listening,
TikTok and Instagram arethese short, engaging,

(39:56):
often oversimplified health claims.
Then you have Reddit and onlinecommunities that fosters this peer-driven
experience that is anonymous,
but there are anecdotal storiesthat often can override scientific
evidence and then thegood old AI chat bots,
which can provide accurateinformation. But just as you said,

(40:17):
Ruth can also hallucinate falsedata and then good old Google
University. Patients searchGoogle for confirmation,
not really for a balanced viewpoint,
it's really how you navigate Google. Ithink it certainly has some benefits,
particularly Google Scholar,
but most of our patients don't know howto really interpret journals and medical

(40:40):
information. And the challenge ispatients are drowning in information.
Our job isn't just tocorrect misinformation,
it's to really help them filter throughthe noise in a way that feels empowering
and not dismissive. So Ruth,
what are your thoughts about that aswe talk a little bit more about the
available age that we're in with data,

(41:03):
but how do we begin to foster thatpartnership with our patients?
I think there are a couple of thingsthat we as clinicians need to do,
and I think first and foremost,
we need to be okay with being challenged.
Just like we are going to talk witha patient about some misinformation,
they may be guidingsome of their decisions,

(41:23):
we're going to bechallenging their thoughts,
what they think is correct, thepatient may in turn challenge us.
And so we need to make sure thatwe are armed with appropriate
ways to engage in a challengingdiscussion that we don't
automatically minimizeor dismiss the patient's

(41:45):
concerns,
that we're able then to havea conversation where listening
is a big part. Remember,
we've all learned about some of the basicconcepts of how do we actually listen?
I'm not just quiet while my brain isthinking about how I'm going to rebut what
you say,
but I'm quiet and I'm listening andI'm trying to understand and I may ask

(42:07):
clarifying questions.
So many of us have learned about some ofthese approaches through processes such
as motivational interviewing wherewe really bring in evidence-based
framework for approaching apatient-centered or patient-based
discussion. At the end of the day, wewant to have a respectful conversation.
We want to be able to listen, andit may actually change our approach.

(42:31):
We may be in a position wherewe say there is new information,
this is going to change then mythoughts regarding your plan of care.
So let's think about this together.
As new information comes in somethingthat we were incredibly wedded to and we
thought, oh my gosh, I'm nevergoing to change my approach.
All of a sudden then we encounternew science, new evidence.

(42:55):
So we need to be just as openas we are asking our patients to
be.
So realizing then this two-way streetthat we are on and that it is a
constantly changing environment, boththe information that is available to us,
but also just new techniques.
How do we deal with the bombardmentthat we are all experiencing

(43:17):
of information that is readily available?
I was telling a colleaguenot too long ago,
I remember kind of in the olddays where if I had a question,
I would consult the librarian whowould then pull the articles for me
and I would have maybe a week or two toreally think about what am I going to do
with that information?
Now I've got informationthat is at my fingertips,

(43:41):
probably more than I know what todo with or more that I can absorb.
So what I have had to do as a clinicianand determine how am I going to
be using information,how am I filtering that?
What happens if my filter'swrong and I learned that I was
incorrect in some of my assumptions?
How am I able to reestablish my course?

(44:04):
And that may mean that I've got to reachout to patients and I've got to put
notes in the chart tosay when they come in,
I've got to reevaluate ourdiscussion or bring in new points.
So my approach with patientshas changed tremendously,
certainly within the last fewyears as information becomes
so readily available and so quickly, andI don't expect that to change at all.

(44:26):
You talked about theage of data. Oh my gosh,
we have data that are increasinglyavailable and people that can be
very convincing even when theyare sharing misinformation.
So it's almost like realizingwhat we are up against and then
thinking about what are the new toolsthat we need to have in our toolkit.

(44:49):
So as an NP, I love casestudies. I know you do too.
You've talked about a number of these,
and so I wanted to use someof the current examples.
You've mentioned a couple that I thinkare really first and foremost in many of
our practices across multiple specialties.
So I want to use a couple of case studiesto highlight some of the points that

(45:09):
we've made.
And these GLP-1 agents that youhave mentioned I think are a primary
topic. I can't turn on thetv, turn on my cell phone,
do any type of internet search withoutreading about this or hearing about
this or friends, family andpatients asking about them.
Everyone is convinced that thesedrugs are perfect for whatever

(45:33):
problem they have, and certainlythere are benefits to the drugs,
but also how do we have theseconversations with patients.
So Paula, can we getstarted with the case?
Let me just throw one out that wehave a 36-year-old obese female that
we are seeing and she'sasking about these agents.

(45:54):
How do we begin to useour knowledge about health
information and misinformationto take us down a pathway of
discussion with her?
Thank you so much, Ruth, and I thinkthat is a great case to talk about.
In my role as an emergency NP,
I often treat many different types ofpatients that present with many different

(46:18):
symptoms, whether they are acutesymptoms, chronic symptoms,
even primary care complaints.
But I think about a patient that comesin with severe nausea and vomiting
after starting a GLP-1receptor agonist that they
purchased without a prescriptionmaybe from an online compounding

(46:39):
pharmacy.
And they were told onlinethat the GLP-1 medications
are a miracle weightloss drug with zero risk.
But the reality is is that thepatient is in the ED with dehydration,
acute kidney injury and delayedgastric emptying due to excessive
dosing and a lack ofproper medical supervision.

(47:02):
And so my role as a clinician isto address first the immediate
medical issue, fluidresuscitation, antiemetics,
electrolyte repletion.
But my next step is to really engagethe patient in a nonjudgmental
conversation about misinformation,
educating the patient aboutthe risk of uncontrolled

(47:26):
GLP-1 use,
not having that medical supervisiontalking about the common side effects,
pancreatitis and even some ofthe prolonged long-term effects.
And so having that conversationnow begins to engage that
patient while they're inthis vulnerable state,
but also not being judgmentalbecause that was available

(47:50):
to them at that moment and offeringevidence-based alternatives,
talking to them aboutsupervised weight management,
behavioral therapy, and evenother FDA-approved medications.
And so this is a stepwiseapproach to being able to
mitigate medical misinformation,

(48:11):
particularly when it presents toyou at this type of situation.
And so the teaching points are thatpatients aren't just making bad
decisions,
they're making choices based on theinformation that is available to them.
And so our role is toprovide better information,
not just judgment, and that doestake some time. You may say, well,

(48:33):
how can you do that in emergencydepartment? It's very time limited,
but we have to integrate time forour patient where we are educating.
Why?
Because we're in a new age ofdata and we are now competing
against data availability.
Now our role as providers is that we'regoing to have to take out that time to

(48:55):
educate. This is all partabout building trust.
How do we want to build arelationship with our patients that is
transparent and also fosterstrust? Remember, trust isn't given.
It's earned and education is key.
And in the age of misinformation,
building a clinician patientrelationship based on mutual

(49:18):
respect is more important thanever. How do we foster trust?
We educate. We start withcuriosity, not correction. We ask,
I should have asked the patient why dothey believe in something before jumping
in with the data? Acknowledgemedical uncertainty.
Patients really respect transparency,

(49:40):
and here's what we knowand here's what we don't.
We know about these GLP-1 agonists,but this is what we don't know yet.
And having that conversationand personalize the information,
instead of saying, studies show this.This was a randomized control trial,
using all these different termsmedically that they don't understand,

(50:00):
really break it down for them,simplify the information,
make it relatable to them. Patientsaren't just looking for information,
they're looking for clinicianswho see them as partners,
not as passive recipientsof medical orders.
And this is where we have thatpatient relationship that fosters

(50:21):
shared decision making. I'm goingto turn it back over to you, Ruth.
I love that.
And a number of points that you madeabout going to where our patient is
that starting point,
understanding them and realizing thateven though we are in situations where we
are time limited,
it is still critical that we identifywhat are going to be these major

(50:43):
points that we need to make,
and then how do we best makethem in a way that is respectful
and that continues to have that levelof trust and engagement with the
patient. And we may think about them.What is our information handoff?
It may be an opportunity for us tothink about who are members of our team

(51:05):
that need to also be involved inthis to be able to provide more
information or make surethat others in our care team
are equally equipped to havethis level of conversation,
or at least we have knowledge and aresharing information about what are the
starting points,
making sure that every individualon our team is recognizing

(51:29):
the information needs of patientsto the same degree and realizes
the important part of recognizing thestarting point to a dealing with a patient
question.
I was at a meeting not too longago where we were talking about
vaccines and vaccination.
Everyone was lamenting the factthat we are seeing such a decrease

(51:51):
in patient trust and confidencewith respect to vaccination.
And I mentioned to the groupthat I know that we all have
fatigue in dealing withhealth issues and patient
questions,
but it is critical thatwe assess our approach
and that at this particular time,I heard over and over again,

(52:15):
I'm tired of the patienttelling me A or B or
C,
maybe the vaccine is going to cause meto be sick or the vaccine includes a chip
or the vaccine is going toimpact my fertility or all of the
misinformation that people had heard.
But the sense within thisgroup discussion was almost
one of we're blaming thepatient for having these

(52:39):
thoughts, and it was verystriking to me that, again,
I want to just circle backto the important discussion that you had about bias
and that is recognizingwhere we may be building
that wall that we are not willing,
whether or not we feel like we don'thave the energy or we are fatigued

(53:01):
ourselves or we don't know how to respond.
We need to find a way to energizeourselves and be willing to have
this level of conversation becauseit's not about blaming the patient.
In fact,
it's about celebrating the fact thatthe patient had a level of trust
that they were willing to bring thesequestions and these thoughts to us.

(53:24):
So the first thing then is thankingthe patient for sharing that
information and acknowledging thenthat they had these questions or
concerns and making them feelthat they are in a safe place for
these discussions.
Because whether we're talking aboutinformation that the patient used to guide

(53:44):
a complete pathway that wewould disagree with regarding an
intervention or whether it's abarrier to moving forward down a
pathway where the patientis open and agreeable to an
intervention,
it all starts with is the patientwilling to have a conversation with us?

(54:04):
Are they willing to take that first stepand then are we willing to go to where
they are and begin to have thislevel of conversation and then think
about what is it that I need thatlevel of self-reflection that I
need to get me to that finish line?
So we've had so many conversations today.

(54:25):
I am so excited to have had so muchopportunity to learn from you and your
experiences, but I want to ask you,
could you distill down maybe threepoints that you want to leave
our listeners with regardingmedical information and medical
misinformation,
things that they can take home and beginto build their own toolkit or their own

(54:48):
self-reflection and self-assessmentfor professional development?
What would those points be?
Thank you so much, Ruth.
I have certainly enjoyed partneringwith you on this conversation that I
believe is crucial.
I think about another example before Iwrap this up with these three takeaways.
Recently,
I cared for a patient in the emergencydepartment who presented with throat pain

(55:12):
and voice change and hoarsenessand had a history of tobacco
abuse since the age of 15 years old.
And he told me that something toldme to come in because I googled my
symptoms and I was concerned thatI probably had throat cancer.
When he came in,
he was tearful and we did his workupand it did show based on imaging

(55:35):
that he probably had throatcancer and we had to deliver the
news. I looked at him and I said,
I'm glad that you Googled thatbecause it saved your life and you
were able to get evaluated.
And so here is a exampleof a patient that I had to
consider the social context. Hedidn't have health insurance,

(55:58):
he didn't have a job,but he had a cell phone,
he had access to information,
and based on the information he had,
it prompted him to come tothe emergency department.
That is what he was workingwith. And I wasn't judgmental,
but I thanked him and tearsbegan to roll down his eyes.

(56:19):
I considered the socialdrivers that were at play here
and I was there to helphim and to educate him.
And so as I think about thisconversation that we've engaged in,
that certainly has beenthought provoking and crucial,
we have to make sure that we, number one,
keep our biases in check continuously,

(56:42):
have that self-reflectionabout how we are being
perceived and how we are alsoengaging with our patients.
We have to pull those down,
pull those biases down so thatwe can see the broader picture,
that we can expand our differentialsand be able to provide care

(57:03):
that is building trust,that is transparent,
that is compassionate and empathetic.
So that's where thatcritical thinking comes in.
In order to build that muscle, wehave to use it so it can get stronger.
We have to understand that truth inhealthcare and particularly in medical
care isn't static. It has to betested, it has to be refined,

(57:27):
and it has to be validated.
Trust is the currency to the carethat we provide, and without it,
our knowledge meansnothing to our patients.
How are we going to build that trust?
And also thinking abouttrust is built through
dialogue. It's not dismissal.Patients need to feel heard before

(57:49):
they are willing to learn. Andfor both patients and clinicians,
we must be willing to challengetheir own perspectives in pursuit of
their truth. Their truth is theirtruth, it's real. And so with that,
I want to encourage our listenersto wash your hands, think critically,
and let's keep challengingmisinformation with evidence and

(58:13):
empathy. I've certainly enjoyedthis engaging conversation with you,
Ruth, and I'm going to take itand put it back over to you.
Thanks so much.
And I want to use this as areminder that we want to celebrate
that we have then this amazing opportunitywith our patients, our families,
our communities, that is built on trust.

(58:35):
And so use this as an opportunityto be grateful that patients
will bring questions and concerns to us.
Try to find out where that patientis and start that journey of health
information, dispelling mythsand medical information.
Find that starting point and walkthat with them as their partner.

(58:55):
And then think about in orderfor us to do our best work,
what is it that we need to do?How do we need to feed our mind,
feed our soul so that we are ablethen to come into each of those
conversations energized andwith renewed energy every time
they happen because our patientsneed us, our patients trust us.

(59:16):
Let's take advantage of that and usethat as wonderful opportunities to
truly make a difference inthe care of our patients,
the care of our communities,
and really the care of ourselvesas we move forward into this
information age. Thank youso much. To our listeners,
I want to remind each of you aboutsome accompanying educational

(59:39):
resource tools that are availableas part of this podcast,
and I welcome you tocontinue to join us in the
upcoming podcast number two and three.
That will help then ourcontinued deep dive into medical
information and how we combatmedical misinformation. Paula,

(01:00:01):
it has been such a delight. I am soexcited to have had the opportunity.
I've learned so much from you. I canhardly wait to put some of it into play,
and I look forward tothe next opportunity.
Thank you all so very much andI look forward to our next time
together.
Ruth and
Paula,
Thank you for this excellent podcast.

(01:00:22):
To our listeners, thankyou for visiting NP Pulse.
This program and theaccompanying clinical tool
were made possible by a medical education
grant from Kenvue.
Continuing education creditfor this program may be claimed
through March 31st, 2026. To claim credit
for this program, loginto the CE center at

(01:00:43):
aanp.org/cecenter.
Search for this program byname and complete the posttest
and evaluation by enteringthe participation code
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