It is critical for physicians to use their long-held trust wisely

During sports physical appointments, I routinely address preventive health topics that range from asking about alcohol, drugs, and sexuality, to addressing accident prevention and updating immunizations.  At one such appointment recently, a young male teen was due for two routine vaccines.  The mother accompanying him had no concerns about one of the vaccines, but expressed concern about the other. A friend had recently shared information on Facebook about how the particular vaccine contained “poisons.”  She was waiting for more friends to “weigh in” on the concern before she made a decision. I asked more about the information her friend had shared, but she hadn’t read it yet.  She allowed her son to receive just one vaccine that day.

I am always disappointed when parents choose not to vaccinate their children for whatever reason.  Vaccines save lives and prevent disease before it can occur, and one less vaccinated person may mean one more disease, with a life potentially changed.  This particular interaction, however, struck me because of how the Internet — especially social media — may be shaping how individuals make decisions, and influencing the very nature of trust.

“Trust” implies an implicit belief in the accuracy, reliability, and integrity of information. Trust typically does not happen overnight; rather, it is built with time and consistency. For example, the trust that develops in a close relationship builds over years and is the product of cumulative positive interactions. Or similarly, trust in an institution is established over years of positive and reliable experiences.  Sometimes trust occurs with a conscious decision, but more often it builds with experience and time.

The Internet is increasingly becoming a trustworthy institution: In general, it is reliable, consistent, and has not let us down.  While some worry about privacy and security, these concerns have not seemed to dampen the trust we place in this vast tool of the information age. For example, it has become commonplace to conduct financial transactions and to communicate confidential information online. Meanwhile, there seems to be an increasing reliance upon collective opinions expressed on the Internet.   Whether it is a product, an experience, or a professional service, online “reviews” matter.  Decisions are made based on a majority of “five-star” reviews versus a few lesser reviews.  This method of making decisions — of trusting — is spreading to virtually every corner of Internet life. Meanwhile, social media communities such as Facebook and Twitter make sharing personal information and opinions easy and routine.

The Internet is a powerful and amazing tool, and has fostered the exchange of ideas and information as never before.  It has been consistent, reliable, and has gained our trust, fostering a revolution of increased reliance on reviews and ratings to base our decisions.

I am concerned about this trend, however, and am worried that this level of trust has insidiously increased to unhealthy and potentially harmful levels as individuals lose track of the foundations of what should be trustworthy information when it comes to making health care decisions.  As is the case with any powerful tool, the Internet has its limits, and as a society, we need to be careful in how it is used. When a mother weighs a decision to vaccinate her child based on the majority opinion of her peers rather than years of scientific research, something has gone wrong.  Research has shown that a patient’s “vaccine confidence” is associated with such attributes as knowledge and trust. My patient chose to use her friends as her knowledge database, and trusted the information shared through social media to make her decision.

The physician-patient relationship has historically been one of trust:  Patients have trusted us that our knowledge and recommendations are accurate and that we have had our patients’ best health care interests in mind.

In today’s age, in which we may be witnessing a potential shift in reliance of who to turn to for information, it is critical for physicians to use our long-held trust wisely. We need to encourage our patients to be mindful of their reliance upon social media and how it may adversely influence their health care decisions.  Whether it is during conversations with patients in the exam room, in our communities, or within the realm of social media, it is time for doctors weigh in and promote trust in the scientific process.

John Merrill-Steskal is a family physician who blogs at Triple Espresso MD.

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