A guest column by the American College of Physicians, exclusive to KevinMD. Because of their unpredictable occurrence, ubiquitous nature, and the fact that they present us with a previously unknown disease to learn and manage, pandemics have always posed a major threat to humankind. And the novel coronavirus pandemic we are currently experiencing is no different. However, compared to pandemics of the past, medical science has made remarkable strides in our understanding of the novel coronavirus, its mechanisms and clinical manifestations, and in developing evidence-based preventive strategies and increasingly effective methods of care as well as a range of therapeutic interventions (including multiple vaccines) in a remarkably short period of time. This has provided us with a historically-unique opportunity to moderate and reshape the typical personal and societal-changing consequences that have always resulted from prior pandemics. Yet, we are now in the midst of a third pandemic surge bigger and more expansive than the previous two, with exponentially rising case rates, hospitalizations, and COVID-19-related deaths. Despite the many historically unprecedented medical and public health successes to date, our collective response to the pandemic has been remarkably suboptimal over the past year, leading to our current situation and its associated devastating outcomes in terms of morbidity, mortality, and social and economic function. How did we miss this chance to maximize this chance to proactively and positively alter the course of this global medical threat? Clearly, one of the most significant factors hampering our societal response to the pandemic has been the widespread questioning, and even denial, of the very scientific facts that have led to these medical accomplishments and are also fundamental to ultimately guiding us through this health crisis. We know that even in the best of times that many individuals are skeptical of science. Most people don’t tend to approach the world in the “scientific” manner that we as physicians are accustomed to, including attempting to objectively evaluate the information for its validity, weigh additional data, and compare the evidence’s strengths and weaknesses to make informed decisions. And the fact that the scientific information we rely upon to make medical decisions and recommendations progressively changes over time as we learn more through this process is certainly confusing to many. Rather, many individuals ultimately choose to believe in and act upon results from a highly complex process subject to many different influences, including cultural, societal, and political forces, many of which are unfortunately significantly detached from objective reality. And while many of these factors were present before the onset of this pandemic, their impact has dramatically escalated over the past year, amplified by the historically new effects of focused, narrow information sources and social media, leaving much of the general public highly susceptible to misinformation that can profoundly alter their world view and personal decision making. This spread of misinformation has, unfortunately, had the effect of creating and advancing an increasing mistrust of science and scientific facts, and ultimately of medical advice, which has sowed discord and severely impaired the effectiveness of personal and public health measures – factors we see playing out during our current struggles to control the pandemic. This diminishing faith in scientific facts and medical guidance is perplexing to most physicians who are logically trying to apply the best of what is known to care for patients while attempting to rationally contain the spread of a dangerous infectious disease. It is also angering to doctors and all health care workers who are willing to put themselves in harm’s way to care for patients. Simultaneously, the behavior of many, based on misinformation, has almost certainly increased their own risk for infection or otherwise thwarted our collective efforts to control the pandemic. This only serves to compound the very personal physical and emotional toll that confronting the coronavirus crisis has exacted on health care professionals over the last year, and adds to the exhaustion, and at times despair, we are all feeling. And it is particularly frustrating now that we have a potential end to the pandemic in sight with vaccines, and knowing that the doubting of scientifically-based behavior by a large segment of the public may make it more difficult to temporize the spread of infection until they can be deployed, or may otherwise discourage people from believing that they are a safe and effective way to ultimately return to a semblance of normal. Yet, the good news is that as the pandemic has evolved, there is evidence that physicians’ faith remains very high across much of the population. And that this faith is based on trust – trust that doctors are acting in the best interests of those they serve, and most importantly, that they provide accurate information when making medical recommendations for both the health of individuals and the well-being of our communities and the country. Truth-telling is a moral imperative for physicians, possibly as fundamental as the commitment to do no harm. It is one of the key reasons why we occupy a privileged position in society as a profession. And it has been rewarding to see how, with a few notable exceptions, the medical community has been able to provide direct witness to the pandemic’s realities and serve as a supportive, stabilizing, and reassuring voice to patients and society during these medically challenging times. Because the rigor of science remains the best ammunition we have against the coronavirus, we have no option but to continue relating the most objective truth known as the pandemic unfolds. And this includes the responsibility to counter the misinformation that can lead individuals and society to make negative health decisions. Yes, we need to fact check incorrect information when we encounter it. But effectively countering misinformation requires that we go beyond simply relating scientific facts to an often questioning and doubting public. It requires that we understand why our patients and communities believe what they do with sensitivity to the personal beliefs and values that many hold, even if they are based on inaccurate or distorted information. Only by engaging others by listening with compassion, seeking empathy, and approaching them in a non-judgmental way are we able to start meaningful conversations that can identify common ground, reduce the disconnect between peoples’ beliefs and scientific fact, and hopefully defuse the reflexive emotional responses and resulting polarization that have been so damaging in the current environment. Asking physicians and other health care professionals to do this, in addition to the incredibly difficult work we have already needed to undertake during the pandemic, may seem like an unfair and undue burden. However, our professional and personal commitment as truth-tellers compels us to do what needs to be done to fulfill our obligation to serve our patients and society. And doing so will be critical in re-establishing the trust in science and medicine that has been lost by so many in recent years. Source
