Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep117: What patients are hearing, with Colleen Denny, M.D., FACOG
Transcript
- 0:00 It's a lot more complicated than it was to be a patient 0:03 20, 3040, years ago, before the invention of the internet. Welcome to off the 0:13 chart, a business in medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the associate editor of medical economics, and I'd like to thank you for joining us today. In today's episode, medical economics, senior editor Richard Peyton is joined by Dr Colleen Denny, the chief ethics officer for the American College of Obstetricians and Gynecologists, or ACOG. They're talking about the growing challenge of medical misinformation and what it means for physicians on the front lines of patient care. Then he discusses how patients are increasingly exposed to unfiltered health information through social media, search engines and generative AI, often without clear ways to judge what's evidence based and what's not. She also explains how misinformation extends far beyond vaccines, touching on contraception, pregnancy care, the use of acetaminophen during pregnancy, and reproductive health more broadly. Dr Denny, thank you so much for joining us. Let's get into the episode. 1:12 Dr Denny, thank you for joining us today. Thanks so much for having me. One of the issues that we're exploring. You know, we talk about a possible war on science or medical misinformation, and sometimes those are strong phrases in your own words. How would you just describe the current state of trust in medicine in the United States? And do you feel like science may be under attack? I 1:35 think it's a pretty complicated question right now. I think in a lot of ways, patients have access to more sources of information than they ever did before, right? They certainly still have us as physicians, but they're also constantly getting bombarded with medical information from social media, from the internet, from generative AI. We're seeing more 2:01 politicization. I would say, of medical information as well, and that just as increased enormously over the last few years and definitely decades. And it's not to say that some of that information online or from social media is incorrect or inaccurate, but there's more, there's 2:20 more opportunities for patients to be exposed to that, to those sources, without the sort of mediation of a physician or someone with medical training. And so I think that there, there are many sources of misinformation that are now directly available to patients, and there's not always 2:39 an obvious way for patients to sort of understand what's high quality information, what's based in evidence versus based in anecdotal experience, what are, what are the sources, and what are the influences of different sources of information? Like it's not always obvious that someone's being paid to advertise the supplement online or something like that, and I think that makes it immensely hard for patients to navigate 3:03 healthcare information. They make health decisions for themselves. It's a lot more complicated than it was to be a patient 3:10 20, 3040, years ago, before the the invention of the internet. And so I think that there is, in a way, sort of this erosion in 3:21 trusting only the medical establishment to give answers to medical questions. That's not all a bad thing. Like we we sometimes were historically not giving patients information about their own care, or like, making it difficult for them to see their own records. However, there's more opportunities for patients to mistrust what physicians are telling them because of these other sources that they're weighing just as heavily as they do in their conversations with physicians. That being said, there's good data out there that when you actually ask patients where they want to get their information about their their health and their health treatment options, they overwhelmingly still say providers they would rather hear from physicians, and you know, advanced practice, advanced practice, 4:07 practitioners a PPS 4:09 instead of having to look on Google or Tiktok or all those things. That's still what they prefer. But sometimes that's not accessible to them, and so they're getting their information more directly through online resources. You know, Doctor, if I may, this is going to be anecdotal, but I am curious about your perspective yourself and maybe some other members of the college that you have spoken to. Can you give maybe one or two examples of, you know, a question that a patient has brought in, citing Dr Google or Dr Tiktok, you know, something that may be sort 4:44 of rooted in truth, or maybe something that's really outlandish, yeah, I think a great example, right? You know, in my world as an OB GYN, contraception is a huge 4:54 source of interest. And I think of misinformation online for patients. 5:00 So they, they often come to me with questions about birth control or contraception, and have heard either from either from a personal source, like a friend or family member, but often from Tiktok or Instagram or googling or Reddit stories, something that they they have heard, is almost always like a downside of contraception, like something that will harm them. And sometimes those things are really pretty benign, like they think that this kind of birth control might make my period irregular. And sometimes it's actually really problematic, like they think that this birth control make them infertile forever. Like those, all that information, and that whole range is definitely out there on the internet for patients to see. So, you know, I think a great example right that's happening right now is 5:46 data about the connection of depo provera, which is a birth control shot, and meningioma, which is this benign 5:55 central nervous system tumor that can cause sort of compression of various structures and can cause symptoms and side effects. So obviously, meningioma is not something we want our patients to be at high risk for. There's more data coming out that it might be a connection between Deborah Provera and this rare type of tumor. That information is out there, and there are many click bait headlines about it. However, the data that we're looking at is not a slam dunk at all, and also it's much more complicated than that, right? Patients are the reason that they're looking for contraception is often because they want to avoid pregnancy. Pregnancy is a much more 6:34 intense physical state and much more likely than meningioma. And sort of talking to patients about like, Well, how do you balance this possible risk versus your real risk of pregnancy? What are your other options? Knowing that you know injectable birth control decreases your risk of other types of cancers, and that's a real finding that we have out there, becomes much more complicated to discuss with patients, but often they've just seen the click bait headline they you know, are worried about it, and they end up feeling like they can't. But there's something wrong with all types of birth control and going without, even if they don't want to become pregnant at that time, in my research, even just in the last few weeks, as well, as you know, the last five years call it, a lot of discussion about medical misinformation and disinformation has centered around vaccines, but that's not certain. That's certainly not the only medical issue that that has taken place, and in fact, you just articulated in another one, the college had put out a practice advisory on acetaminophen use in pregnancy and neurodevelopmental outcomes. Yeah, do statements about other treatments and interventions kind of also end up muddling the medicine, so to speak, for physicians and patients. And I don't want to, I want to necessarily misspeak for the college, but it appeared as though that that was put out in response to the FDA advisory that had gone out regarding warning letters to physicians about that possible link, even though it appears that there, there had been other scientific research that had found acetaminophen to be, you know, a helpful and useful 8:05 anti fever and anti inflammatory medicine during pregnancy, and when the F, I guess, that's put to find a point on it. But when FDA makes those that type pronouncement, do doctors have to get involved to to counter what may be misinformation. Yeah, I think, 8:23 you know, we do have a responsibility. I think I personally have a pretty strong stance on this. I feel that we have responsibility to advocate for our patients 8:33 in sort of for their health in a very broad sense. Like I think we have an a responsibility to advocate for better health care systems, you know, more just insurance policies, pretty broad ideas of what makes someone healthy in our society, but an even more narrow and conservative interpretation of that. I think we certainly have a responsibility to voice what our training has taught us. Like this is obviously a medical question which we have training, on which we are trained to interpret research on and to see something projected at a very high level and getting a lot of attention that goes against that training and that expertise. I do think we have a responsibility to sort of clarify, 9:15 sort of call out exactly what is being said, and then to clarify our own stance, like we in many ACOG recommendations, we actually say that Tylenol is the number one thing that we recommend for people who are in pain or have fever 9:31 or for whatever reason, need some sort of, 9:36 you know, anti febrile agent during their pregnancy. And so we have a direct conflict between what we're saying as OBGYN and then what the FDA is putting out. We have a responsibility to help patients understand that conflict, like why, why is our stance what it is and how, what? How we interpret that, that FDA statement, and what they we think that their their position, why we think their position is erroneous? Want to get into some more detail. 10:00 About that, but just sort of big picture. Do you want to give a plug? Because I know that the college website had, frankly, a pretty lengthy list of resources that physicians and patients can reference, absolutely. So the American College of Obstetricians and Gynecologists is sort of the largest professional group of OBGYNs in the country. We 10:19 have many committees that sort of 10:22 have different interests in OBGYN, everything from clinical practice, right, like making sure that we're up to date in terms of our recommendations for people during their pregnancy care to something like me, where we're actually looking at bioethical questions in OBGYN. And we make a lot of materials for our members targeted OBGYN and people who provide pregnancy or, you know, reproductive health care, journals articles, resources for talking to patients. But we also have things for patients for understanding sort of everything from the schedule of prenatal care to what are fibroids to different types of cancer that affect gynecologic organs. There's a lot of good resources out there, and I want to know, I'm very proud of the American College of Obstetricians and Gynecologists, really, in the last couple of years, they've taken a stronger stance on really advocating for evidence based medicine, saying 11:14 we recognize that non medical sources are getting louder and louder voices about what's medically appropriate, or what's medically safe, or, 11:24 you know, legislating around reproductive health care, and the college has sort of taken a stance and pushed back and say, like, No, we are the experts on this. We've devoted our whole lives and our whole training careers. This is what we know. Here is how you can access that. And I think I really am proud of what they've done. I think there's more to be done, but I would recommend it to anybody who's providing sort of reproductive health care and patients who are interested. There's definitely stuff at the patient facing level that can be beneficial. 12:01 Hey, there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow. Hack an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds, at mjh, life sciences.com, with your topic, quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. 12:52 To expand on the notion of physicians communicating sometimes, frankly, there are some physicians who are online. They have a big social media presence and a following, and they may be offering some really good, incredible information. Sometimes, when doctors speak out, they may be attacked online. Do you think it's beneficial or, I guess, how would you describe the best ways if a physician wants to create more of an online social media type presence to counter some of that misinformation? Is that a good idea? Firstly, to start, and then, how do you do that? It's a great idea. I think that maybe historically, especially in academic medicine, we've sort of sniffed at this form of communication with patients, right? We sort of call people Tiktok doctors, or, you know, if people have, like, cute little videos on Instagram or something like that, there's a sense that that's not really like 13:44 that's not really doctoring. We sort of have this, this sense of ourselves 13:49 as being sort of 13:52 more high brow than that. We're publishing in academic journals. We're not We're not on Tiktok, but I think it's totally a mistake, and I I 14:01 think we have to acknowledge the reality that our patients are getting a lot of information from those sources already, no matter what we do, even if they would prefer to talk to us, they might not get to we might be too busy, they might not have insurance. They're going to be getting information from online and social media resources. So we need to be there. We need to make our make our information palatable on those resources. You know, cute little videos are they're popular for a reason, and we need to figure out how to make them. We need to understand sort of the algorithms that put that information in front of patients, as opposed to the many, 14:40 maybe untrained people who are also offering medical advice based on very poor evidence or personal interest or things like that. We need to acknowledge that our competition is misinformation and that we have to meet people, patients where they are. I think doing that is quite hard. You know, people are a. 15:00 A 15:01 people are full time social media social media influencers, right? This is their whole job is to produce that kind of content and understand the algorithms and put it in front of viewers and consumers, and to ask someone who's truly a practicing physician to do that is difficult. I certainly have tried to do that a little bit myself. I'm in great admiration of people who 15:26 do that well as physicians, you know, putting high quality information in a way that sort of works with that, that style of 15:34 production. But I do think that my hope is that 15:40 practices, especially independent practices, will give physicians a little bit more support as they try to do that right? This is, this is advertising. This is, you know, building your practice. This is something that takes time, and it takes time to do it well. Our main audience is primary care physicians. What would you like to say to them? Or what would you like them to know primary care physicians are doing, doing God's work as we, as we say, it is a really hard role, and is a really hard role to do. Well, I'm in great admiration of primary care physicians as a sort of sub specialist. 16:18 I think you know from, from my perspective, as an OB GYN, I think that reproductive health care is in a tentative place right now. 16:29 There's a lot of politicization around, you know, certainly hot button issue, issues like abortion care and access to abortion, but even all the way down to like hormonal treatment for people in perimenopause, there's just a lot more discussion of that in a much higher level, and patients are going to come to you feeling much more conflicted than they might have in past years. I think having 16:54 having a basic knowledge and a basic, up to date knowledge of main common concerns in women's health care, reproductive health care, in terms of, like, birth control, abortion care, 17:09 menopause care, those are patients are going to come to you with those questions, and they're going to have received a lot of misinformation at every possible level, including, like, the national level at this point. And it doesn't mean you have to know all the answers, but you should know sort of 17:24 a sort of foundational information about it, and then also partner with an OB GYN, right? We love having partnerships with primary care doctors. We are using telemedicine more than we ever did before. We can be a resource for those questions. Rather than feeling like patients are 17:41 either not getting answers they need or getting bad answers from the internet. Primary care is being asked to do so much at the same time, 17:51 you will see a lot of patients who come to you first with these questions, and I think 17:57 being able to have a at least a superficial knowledge of what what what they're looking at, what they're going through, and what is actually evidence based answers, but also having an OBGYN number in your back pocket to pass them off to is is going to be more important now than probably ever before, certainly in my career. You touched on this point a moment ago, because in my research so far, a lot of the conversation, frankly, has really revolved around vaccines. Of course, that's certainly, like I said, not by any means, the only area of medicine that is subject to misinformation and disinformation. I was kind of dancing around that question because I wanted to maybe talk about some of those other issues. But you had mentioned that right now, and I just didn't know if there was any any other additional points you wanted to talk about, very specifically about primary care OB GYN and vaccine hesitancy among patients? Yeah, I was looking at your questions beforehand. And I think that in my world, aside from the sort of vaccine hesitancy and the sort of primary care standpoint, I think vaccination during pregnancy has become more of a hot button issue over the last couple years because of vaccine hesitancy generally, and there are such specific benefits to vaccination during pregnancy, both for the pregnant patient themselves, but also for the baby, that it just sometimes when you have someone's vaccine hesitancy from other parts of their their lives sort of trickle into their pregnancy, become You sort of have to really talk through what they're worried about and why this is this, 19:25 even regardless of what they think outside of pregnancy. This is really important, and I can sort of help you think through why you might choose to take these vaccines, even if you have concerns about other vaccines because you're pregnant like this is a this is a special situation. The other thing that often comes up is the HPV vaccine, and that's not a pregnancy related vaccine, but that is, that is a vaccination that has really changed, 19:52 truly, like it's changing the face of cancer, cervical cancer in the United States. Like it is, it is a vaccine that prevents. 20:00 Cancer, and somehow we've gotten tied up in this conversation where we've lost that message, which is absolutely true, and have become like mired in this conversation about vaccine hesitancy, or that somehow, like having this vaccine against cervical cancer will cause sexual promiscuity. And it's sort of, it's such a PR misfire that this is the conversation. But trying, as you're talking to patients about HPV vaccination, to try to reframe it in in that way, like I, I, when I talk to patients who haven't had an HPV vaccine, I'm like, this, is this? This is a, this is a way to prevent cancer. Like we don't have any vaccines like this. This is incredible. It's it has really no risks, and it makes a huge difference in terms of, like, your your long term risk for cervical cancer, which is, you know, less common now that we have pap screening, but is still killing 1000s of people every year in the world. And so I think those two things come up a lot in OBGYN land, 20:59 but both of them involve sort of reframing the discussion about what this vaccine is and specifically how it's going to benefit you. Like, it's not, 21:08 it is a population benefit, as all vaccines are. But also, if you're pregnant, it's for you and your kid. If you are thinking about HPV vaccination, it's for you. It's not really like a population benefit, only like some of the other ones, like you know, most people aren't going to come in contact with polio. Almost everyone will come in contact with HPV at some point in their lives. So that, I think that often my conversation around new reproductive health vaccines is a little bit different than many other types of vaccination that we do. But that's fine, right? People can feel like it's tailored conversation for them, and that might make it easier for them to reconsider or change their mind. Maybe one more quick question, if I may. I and you touched on this point earlier, and I it was something that maybe just sort of a shout out to our physicians to remember that because you talked about how you know people when they go to the doctor, when they're face to face with their with their physician, the doctor still has a great deal of credibility with them. Is that something that physicians need to remember on a day to day basis? I think yes, 22:09 if, if nothing else to remember after a difficult conversation with a patient, 22:18 to 22:20 sort of diminish that feeling of burnout. I think it can be really disheartening as a physician to feel like you're offering people, you know, evidence based care to the best of your ability, to have someone just say, like, Nah, I don't want that. I read somewhere that that's not good for me, that feels so hard, especially in a system that's constantly overworking, especially its primary care doctors. 22:44 I find those, I find those articles about how patients still prefer to get their information from physicians and still trust them to be sort of heartening, in a way, to try to like, hold that kernel of hold that kernel of truth in in your heart as you're talking to patients, even if they tell you that they don't believe you, right? They're coming to see you for a reason. They they still want to have that conversation with you. And sometimes, when I'm talking to my trainees, my medical students or my OBGYN residents, I often say, like, a conversation, including about vaccines, is almost like a shot across the bowel. Like, this is someone who's declined her flu shot in pregnancy. And say, like, well, you know, this is why we recommend flu thing I was talking about, it make it safe. It's more dangerous for you to get the flu. It protects your baby after the baby's born. And we think that this is so important for you specifically that we're going to mention it at every visit. It's not because we don't we want to bother you or anything like that. We just think it's so important for you. And sometimes that conversation, we actually did data in my did research in my hospital about covid vaccination. The number of people who declined the covid vaccination the first time during pregnancy and later accept it is quite high. So I think, like you know, remembering that this is part of a spectrum of care, not everybody, but many people you're going to see again and setting yourselves up to later come back to that same conversation, reiterate those same points, sometimes will be successful, even if it doesn't feel good the first time. And I think part of that is related to the way that people do trust their physicians. They trust consistency of messaging, and to give yourself a break when a patient doesn't necessarily take your advice the first time, and then comes back to you. They trust you. They are coming back to you. You can have that conversation again, even acknowledging that you've had the conversation before, because it is so important. I'm Richard payer chin, reporting for medical economics. My guest today has been Dr Colleen Denny, chair of the ethics committee of the American College of Obstetricians and Gynecologists. It's been a great conversation, and thank you so much for taking the time. It's been a pleasure. Thank you 24:59 once again. 25:00 Was a conversation between medical economics senior editor Richard Pearson and Dr Colleen Denny, the chief ethics officer for the American College of Obstetricians and Gynecologists, or ACOG. My name is Austin Luttrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you think the best stories that medical economics and physicians practice published delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicianspractice.com off the chart a business in medicine. Podcast is executive produced by Chris nazolini and Keith Reynolds and produced by Austin Latrell. Medical economics and physicians practice are both members of the mjh Life Sciences family. Thank you.