The medical misinformation crisis is a crisis of access to doctors
My patient Claire and I disagreed. She was 44 years old and came to my clinic for a second opinion. The diagnosis was stage 3 rectal cancer. It started with blood in her stool and quickly progressed to weight loss and abdominal pain. I agreed with his previous doctors’ recommendations regarding surgery, radiation, and chemotherapy. She asked about mistletoe, blue scorpion venom, and infrared lamp therapy.
We talked for 30 intense minutes, but at the end of the visit she still wasn’t convinced. It was all I could do not to chase her back to the parking lot. Claire, whose contact details I have slightly changed to protect her confidentiality, would die young from a treatable illness.
She is not an anomaly. A recent survey by the Physicians Foundation found that more than half of doctors cite misinformation and disinformation as hindering their ability to care for their patients. Nearly 9 in 10 people believe this figure has increased over the past five years. As an oncologist and internist for a decade, I can attest to this first hand. I can recite the latest trends online without clicking a single link. On a daily basis, I debunk the “cures” peddled by wellness companies and the unproven supplements offered by social media influencers. I unravel the political twists that call into question routine procedures, and I reassure against mind-blowing AI chatbots that jump to the worst diagnoses.
No one has a clear solution, although most focus on how health workers communicate. Medical societies, hospitals, and even the U.S. Surgeon General’s Office have released toolkits and training to help us engage those with whom we disagree. The general principles are to listen, ask questions and respond with empathy and without judgment.
Yet these tactics assume something conspicuously absent: a doctor the patient can actually reach. It’s no coincidence that medical misinformation hits hardest as access to medical professionals has deteriorated nationwide.
The average wait to see a new doctor in the United States today is 31 days, up from 26 days in 2022 and 21 days in 2004. Once considered a problem of geography (rural areas) or specialty (family medicine), delays are now a critical part of American health care. I try to refer my patients to a neurologist or psychiatrist, and they make an appointment for the following year. Some clinics send me a form letter – the wait is so long they don’t even make an appointment. Try again later.
This is a crisis in its own right, but we have accepted it, normalized it and, worst of all, misunderstood it. The most common explanation invokes supply and demand. There is a shortage of doctors as patients age and become sicker. Yet this doesn’t really hold up to national data. It doesn’t explain why it sometimes takes 231 days to see an obstetrician-gynecologist in Boston, where there are many doctors. It also does not account for the reasons why patients have difficulty seeing their regular doctors. My own patients wait three months to see me.
The truth is that there is less supply and demand and more of a deep mismatch of work, in which doctors’ expertise and patients’ needs do not match. Today, the bureaucratic work required to advance patient care has exploded. Cluttered electronic records generate more than five hours of recordkeeping for every eight hours spent with patients. Doctors’ offices spend more than a dozen hours each week on the phone or writing letters to insurance companies. Yet the basic infrastructure needed to provide this care has not adapted. Payment models reward assembly lines of consecutive visits as the sole currency for medications and compress each one into 15 minutes to fit more.
The result is a cascading failure. A typical primary care physician has 2,500 patients and needs 27 hours a day to care for them. When busy GPs can’t do everything, they refer patients to specialists for problems they could otherwise manage. Specialists do the work of generalists; general practitioners do the work of nurses; nurses do the work of medical assistants; and medical assistants do the work of assistive technology. With all our misallocated time, artificial scarcity turns into real scarcity. Doctors are burning out, working part-time, and leaving medicine entirely in record numbers.
Although losing doctors to paperwork seems horribly fixable, most ideas for improving access overlook this reality. Sending more medical students into a system that chews them up and spits them out does nothing to help patients. Increasing residency places is the same dead end. Deploying doctors to rural areas does not solve the problem nationally. And increasing coverage for patients is not the same as improving access; even the best insurance does not guarantee an appointment.
The consequences go beyond the inconveniences. Patients, who desperately need help and cannot receive it from professionals, seek it wherever they can find it. The winners are the scammers who clear the low bar by simply showing up. The losers are everyone else.
The positive side of this story is that the opposite is also true. Consistent access to a doctor directly increases confidence in the facts. Surveys show that although Americans have lost some trust in medical institutions, they continue to trust their personal physician as their primary source of health information. Meanwhile, they maintain a healthy skepticism of others. While more than half turn to social media, for example, less than half trust it. Compare the doctor you know to the most charismatic TikToker, and the doctor will usually win. I have successfully convinced unsure patients to undergo essential tests and treatments and avoid depleting their limited time and savings. Often it takes more than one conversation, and some patients are so overwhelmed by misinformation that it doesn’t work. But most are not combative; they are grateful for the clarity. They do not prefer option B; they settle for it when option A is not available.
To fight against unwanted medicine, we can and must lead external battles. On health, we can push for regulation of social media, hold companies accountable, protect AI chatbots, and put political pressure on public officials who act as a fountain of lies instead of correcting them. But that’s not enough. Playing Whac-A-Mole against misinformation is a losing strategy when it appears in other forms. And while some doctors are turning to social media themselves to insert good content into a sea of bad, that’s not the same as a relationship that adapts to individual circumstances. What matters most is a reliable home base to set the record straight.
Healthcare organizations must invest in creative solutions to restore the division of labor that will allow doctors to see their patients and patients to see their doctors. Broadly speaking, these can be broken down into technology, team and time. Technology: Radically improve electronic health records to serve the user, simplifying physician workflows instead of convoluting them. Team: The same article showing that primary care physicians work 27 hours per day, estimates 9.3 hours with support teams, including nurses, nurse practitioners, social workers and pharmacists. Finally, time: Expand reimbursement beyond fee-for-service to account for time spent caring for patients outside of assembly line visits, such as phone calls and messages to patients. Implementing any of these changes will help prioritize the doctor-patient relationship as an antidote to busting myths and saving lives.
Sadly, Claire died of curable cancer. I asked her to follow up with me, but with a few months until my first available appointment, she continued to check other sources. Instagram suggested cutting back on sugar to starve the tumor. A podcast recommended ivermectin. Politicians regretted the vaccines they received decades earlier. I lost it due to lack of access; quickly, it was filled. Later, I learned that amid the noise, ChatGPT was saying something remarkably specific, if not entirely impractical: “You should see your doctor.” »
Ilana Yurkiewicz is an associate clinical professor of medicine and oncologist at Stanford University and author of “Fragmented: One Doctor’s Quest to Rebuild America’s Health Care System.“
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