Combatting Misinformation with Empathy
02.1—Research shows empathetic health communication drastically improves patient treatment reception and outcomes. Can it help us overcome COVID-19 misinformation?
Hello and welcome to Issue 02.1 of Multitudes.
Written by me, Stephanie Zeller.
✨ Happy October! If you’ve already subscribed: Hey! Hello! Thanks for being here. If you haven’t: I forgive you, but good news: you have endless opportunities to do so!
This issue went out a little later than I’d planned, but I’ve been writing a grant and have therefore been completely swamped. So, here’s to a birthday edition of Multitudes! (Somehow, enough time has passed that I am now 24 entire years old.) 🎃
October has always worn the honorary best-month-of-the-year badge in my view, and not only because I’m biased toward the day I was born.
I looked forward to the Blue Angels’ annual air show, held directly over my house every October. I watched the jets carve up clouds with their sonic booms. I decorated pumpkins and trick-or-treated. The weather was clean and clear and cool.
But this beautiful time of year also reminds me that four years ago, I was confined to a hospital bed, wondering how I’d survived an accident that should’ve ended my life before reaching my twenties.
Falling five stories onto a cement slab shattered by elbow and broke my jaw into so many pieces it was no longer part of my skull. I was in excruciating recovery for months—I passed out from pain more than once in the hospital, a bodily defense mechanism that honestly never came soon enough.
The scope of my situation and the paralysis in my left hand revealed themselves slowly through the painkillers. The elbow damage had nearly severed the ulnar nerve—the bundle of electrical wiring that carries signals for movement and sensation all the way down into the pinky-side of your palm.
That nerve is attached at the elbow, and its degeneration meant I couldn’t access the muscles in my palm and fingers. Those muscles start to atrophy without constant use the way your abs disappear if you stop working out for a few weeks.
I was assigned a regimen of daily physical therapy and weekly orthopedist visits. My doctor was a kind man who wore cowboy boots and spoke with gentle intentionality. He took time to explain the biology behind my paralysis, he indulged my probing questions, he was forthright when I asked and encouraging when I felt hopeless.
My frozen hand was almost impossible to reanimate, he said, but there was a sliver of a chance it may improve. He gave me realistic timelines for a spontaneous reemergence of sensation, and when those deadlines came and went, he remained understanding and auspicious. “Keep working on it,” he’d say. “You never know.”
I clung on to that tiny piece of hope and attended physical therapy religiously, went hiking, tried to live. One day in the shower, months after my accident, I felt pinpricks of heat on my palm. I am now typing this article with two fully-functional hands. I can feel the keyboard on my fingertips.
I didn’t give up because my doctor didn’t give up on me. Doctor-patient relationships are a delicate dynamic with acute power imbalances—had my orthopedist decided to spare me the misery of pulling for 1/100,000 odds, I wouldn’t have recovered.
After my accident I began reporting for the Texas Health Journal on research concerning empathetic communication and patient outcomes. The doctors conducting this research were finding that well-executed doctor-patient communication, like what I’d experienced, wasn’t merely a creature comfort—it defined the arc of a patient’s recovery.
“People talk about a hierarchy of expertise, knowledge, power, control…we’re constantly trying to find ways to balance that,” said David Ring, MD, PhD, principal investigator, Associate Dean for Comprehensive Care and Professor of Surgery at the Dell Medical School. “We don't want people to feel that we don't care, to feel dismissed, to feel that we’re belittling their concerns or that we’re being arrogant, and yet, [according to our research], they do.”
Dr. Ring and his colleagues found that poor communication strategies correlated with dissatisfied patients who felt condescended or ignored, and who therefore couldn’t build trust with their doctors. During office visits, doctors were focused on efficiency of information delivery rather than the quality of the nascent and fragile doctor-patient relationship.
Trust, according to Dr. Megan Ranney, an ER physician and Brown University professor, is the key ingredient to patients following doctors’ orders, despite the imbalance of knowledge and power.
“We have two main jobs: to diagnose, and to treat,” said Ranney. “Both require trust; and empathy allows for trust and honesty. I've had patients tell me that an interaction was the ‘first time they felt heard,’ before promising to change the way they take their medicines, before finally accepting a diagnosis, or before agreeing on a plan of care.”
Unfortunately, the pandemic has changed everything about this kind of patient care. Doctors are no longer able to engage in the kind of face-to-face, intentional conversation with patients that helps them construct an island of trust in a sea of fear and uncertainty.
“When I walk in a room in full PPE, I look like an alien,” said Ranney. “When a patient has COVID-19, I try to minimize time in the room in order to reduce my own infection risk.”
This communication disconnect has expanded far beyond doctors’ offices and hospital rooms. Trust in science has been disintegrating along party lines for several years as scientists, researchers, and doctors have struggled to reach increasingly segmented and isolated audiences.
The pandemic has cut us off from direct contact with what research says are our most trusted sources of information outside of personal physicians—our friends and family. In the absence of these groups, we have the media, but they can only do so much when highly visible sources (The White House) are remaining conspicuously silent—or worse, actively misleading the nation.
In public relations, we call this the Information Vacuum—the period of time between an Event and when information is released with details about the Event (the Who, What, When, Where, and Why).
For example, if a chemical plant has an explosion, that plant should begin to release information pertinent to the public as soon as possible, even if it’s incomplete, otherwise the public will be forced to speculate and fear will dominate reason. The plant will need to shift its energy to counteracting misinformation, defending itself, and trying to convince a suspicious public that they aren’t in immediate danger. (Think: Chernobyl—a test case for horrible public health communication).
America’s COVID-19 response has mirrored this bad model point for point, and we’ve watched it unfold like an interminable, slow motion car crash. The challenge we face now—as a society on the wrong side of the information vacuum—is communicating vital public health information to people who no longer want to hear it.
“Unfortunately, in today's environment of soundbites and partisan talking points, it's too easy for patients and the public to get confused about what the truth is, and about how best to prevent or treat a COVID19 infection,” said Ranney.
“It's also far too easy for them to feel judged.”
As Dr. Ring et. al.’s research demonstrated, and as I personally experienced, when a person feels judged—ignored, condescended, backed into a corner—they are much less likely to process medical advice and to take action for their own good.
The key to overcoming this disconnect may lie in empathetic communication, which can only come from time, an open ear, and intentional connection. In the absence of one-on-one doctor-patient experiences, consistent national information, and frequent in-person contact with a network of loved ones, we must work as a community to encourage adherence to public health guidelines not with strong-arming or fear-mongering, but with empathy.
We can contextualize and humanize these guidelines—on social media or elsewhere—by sharing authentic experiences like the one that opened this story.
We can check in on our peers, colleagues, friends, and family, with acceptance of their experiences and their fears, and start discussions about working through this strange time responsibly for each other’s benefit.
Finally, we can educate by setting behavioral examples and talking honestly about both our choices and our misgivings.
“It's critical for us to continue to share our experiences on the front lines, to give a human face to this pandemic and to provide clear recommendations on how we can move forward,” said Ranney.
“Our voices matter. If we aren't part of the conversation, we are part of the problem.”
Hi there! Thanks for reading. If you like what I’m doing here, you should tell your friends. If you’re interested in keeping up with me, you can find me on Twitter @StellerZeller, or on Instagram, @stellerz.
Big big big fan, as always !!!