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“There are two battles waging from the COVID-19 virus this year: the obvious fight for human life but also the attack on science. During philosophical and political debates, one steadfast weapon has been the scientific method. Opinion doesn’t matter. State the facts. The thing about facts are, though, that one has to be willing to change previously held points of view with new information. One of the most devastating things observed during this pandemic with regard to human behavior is an absent quest for verity. Instead, it’s ‘click, copy, and paste.’ Somewhere in there, the part where the information is evaluated was lost.”
Alicia Billington is a plastic surgeon.
She shares her story and discusses the KevinMD article that she co-wrote, “In the age of misinformation, don’t be a contributor to the problem.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Alicia Billington. She’s a plastic surgeon, and she wrote the KevinMD article “In the age of misinformation, don’t be a contributor to the problem.” Alicia, welcome to the show.
Alicia Billington: Thank you so much. It’s an honor to be here today.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?
Alicia Billington: Sure. So my background is a little circuitous. I started off as an engineer. I studied at Cornell and just really loved math and statistics, and eventually found myself on my way to medical school. I went to the University of South Florida. I did my PhD in biomedical engineering, and I ended up in a plastic surgery residency program.
Because of my passion for math and health policy, I sort of got involved in medical advocacy, and I created a group on Facebook, actually called Medical Advocacy, about 11 years ago. I believe that one of the responsibilities of physicians is to advocate for their patients and their professions, and that is why I got involved in medical advocacy. So I certainly welcome all of your listeners to follow at Medical Advocacy if they are interested. The goal of the group is really just to create a cordial, respectful environment where we can discuss different points of view.
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Kevin Pho: Wonderful. And how has the pandemic affected both you and your practice?
Alicia Billington: Well, I was a resident during the peak of the pandemic, and with plastic surgery, most people sort of think of the cosmetic, elective side of things, but I was actually at Moffitt Cancer Center. And cancer does not wait on the pandemic. So it was something that we worked through, and we were still pretty busy, despite there being a lot going on. The hardest part was that a lot of the patients’ family members couldn’t come to appointments where they typically would come. So we had FaceTime, but we were still able to take good care of our patients.
Kevin Pho: So let’s get into your KevinMD article, “In the age of misinformation, don’t be a contributor to the problem.” For those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?
Alicia Billington: Sure. Part of my daily routine is that I wake up and I log on to the various places where I get my medical information from. Part of that is also going on to social media and seeing what the pulse is in society, what they’re seeing on social media and medicine. As the pandemic was progressing, I was becoming more and more frustrated. There was just such a negative vibe on social media, and there was a lot of misinformation. It came to a head when I started seeing a few family and friends that I really respected posting information that I knew was just completely wrong.
So I figured that I needed to figure out a way to change this narrative. What I found was that, for me, I needed to ask myself why they believed what they were posting instead of getting upset with them. I ended up being a lot happier approaching it that way as well, because I had talked to a lot of friends, and we were all feeling the same thing, just a lot of negativity with all of this inaccurate content. So I wanted to reach out to other people who might have felt the same way I did, to talk about what we can do as physicians and members of the medical community to combat this.
Kevin Pho: So I think misinformation, especially on social media, is a huge problem, especially during the pandemic. I think I’ve seen studies saying that Facebook actually is the leading source of misinformation regarding COVID-19. Now, if you have patients who come to your exam room and they’re reading a conspiracy theory or a clear falsehood about the pandemic, what are some of the techniques you use to approach them when they present you with misinformation?
Alicia Billington: I think the most important thing to do is to approach them with kindness and openness and to listen. If you come in and say, “You are wrong, I am right,” you have shut the door on any opportunity to help educate them about what is going on in medicine. So you really have to work as a team.
What I like to do is this: Usually these articles have pieces of information that are accurate. I like to say, “I really agree with X and Y that you said. But here’s my thought on Z, and here’s why I think this,” and I support it with evidence from medical journals. What that does is it opens the patient up to hear your perspective, versus them saying, “You know what, this person doesn’t understand,” or maybe thinking you’re on a different political spectrum than them. I always try to keep it strictly with regard to the science and keep the left and right viewpoints out of it, and I have found that a lot of patients are a lot more open to what I have to say because of that.
Kevin Pho: One of the things that you advocate for is for physicians to go on social media. I advocate the same thing, but some of the pushback I get is that doctors are too worried about the pushback that they’ll get. The more provocative a topic is, the more pushback they’re going to get online. What are some tips that you could share with clinicians who may be a little bit afraid of speaking out on social media?
Alicia Billington: I think that is an excellent point, because it’s something that I think about every single time I make a post. Often, after I make a post, I sit there for a few minutes and I think, “Oh my gosh, should I go back and edit that? Should I word that differently?” I ask those I’m close to who also follow me on social media, “How did you perceive what I wrote?” I think that it is important just to get out there and try, and you learn as you go to some degree.
But always do the mom test: If my mom saw this, would she be upset with me for the language that I used or the way that I worded this? I’ve found that that keeps me out of trouble a lot of times. And I always go back to the science. If you are substantiating what you’re saying with facts and not opinion, you’re usually safe.
If you find yourself getting upset, or it’s a heated topic, just walk away from it. Take a couple of minutes and then come back. Sometimes you’ll prevent yourself from posting something that’s going to upset someone else. But the goal is that you’re getting on there and educating everyone about a topic, and sometimes that does take a couple of minutes to remove the emotion from it.
Kevin Pho: One of the things that you mentioned earlier is that you are part of a Facebook group. Now, how are Facebook groups in general different from, say, an open Facebook page?
Alicia Billington: I have learned so much over the last couple of months about how Facebook works that I really didn’t understand. What is interesting about a group is that it allows people with a common interest to come together, and it’s private. You have to join it to be a part of this community. There are a lot of pluses to Facebook groups, and I actually have one. Mine, I think, has been pretty successful, because it’s something where people can share personal information.
The problem is that a lot of these groups are infiltrated by other individuals who do not share the same interests, and sometimes they’re going on to these groups to try to persuade people to believe some of these conspiracy theories. I really wasn’t aware of all of this, or at least of the degree to which it’s happening, until COVID came about. But there are some really great resources about disinformation and misinformation. Nina Jankowicz is a disinformation fellow at the Wilson Center, and she’s written extensively on that, which you can link to from my article. And there’s a great book called The Misinformation Age. Sorry, my dog’s barking in the background.
Basically, what Facebook groups have done is give people a way to share common interests, but sometimes those interests aren’t so good. One of the problems with Facebook is that when you like one group, Facebook has an algorithm that sometimes can encourage you to join other groups that have more nefarious goals. So that’s the difference from a page, which is something that’s open, that everybody can share and see, and it’s more transparent to the community.
Kevin Pho: Some of the listeners to this podcast are very versed in Facebook, and they run their own groups. One of the things that you mentioned is the civility that you experience with your Facebook group, and that’s not always the case. Now, what are some tips that you could share in order to maintain a civil discourse online?
Alicia Billington: Well, at the moment, I’m at around, I think, 900 members, so it’s definitely a lot easier for me to manage than for groups that have 9,000 or 90,000 members, because I can moderate all of the comments. We put the goal on the page that we’re here to hear each other’s opinions, but mainly we wanted to see the evidence-based medicine. Anytime it gets away from that, the comments get deleted. I really haven’t had to do that, though. I mean, I have been so impressed with how people have responded.
I think part of it is also the posts that I put up. I post very controversial topics, and when it gets to the point where I think, “Man, this might be a heated topic,” I put a reminder at the end, like, “Hey, let’s keep this civil, and please be professional.” And really, it hasn’t been a problem. I think it’s because the posts are literally matter-of-fact, and not, “Hey, this is what I think.” I do think that that contributes to the overall atmosphere of the group.
Kevin Pho: We’re speaking with Alicia Billington. She’s a plastic surgeon, and she wrote the KevinMD article “In the age of misinformation, don’t be a contributor to the problem.” Alicia, in addition to COVID-19, we obviously have an election coming up, and misinformation online is going to play a huge part in what goes on in both of those issues. Now, do these platforms themselves have a responsibility to police the information that appears on their platform?
Alicia Billington: This is such a hard question. I know that Facebook has been struggling with this, especially since the last election. One of the interesting things that I’ve learned through studying this is that the most widely spread articles and posts in the last election were actually misinformation.
So I’m going to give you a quote that one of my attendings told me when I was on trauma surgery, and that is, “Trust no one, expect sabotage.” To me, what that meant was that you have to question everything, and you have to make sure that if something’s really important, it gets done the right way. So you have to go to the primary source. You can’t just take a quote-unquote news source at its word. You have to go back to the original article.
As far as the election goes, I do think that Facebook does play a role in people’s perception of news, and I do think that they need to, in some ways, screen the news for things that are blatantly wrong. Now, if someone has an opinion and you disagree with it, I don’t think that should be removed. But I do think that it is really important that this happens, because it’s not just members of the United States who are influencing what we do; it’s also other countries that are coming into play, with some bad things in mind, to try to direct how the election goes. And I think that that’s very scary. So that’s a tough job for Facebook and for the other social media giants out there, but yes, I do believe that they have a role to play in this.
Kevin Pho: And what’s your number one tip that you could share with clinicians who do want to go online and clear up all that misinformation out there?
Alicia Billington: I think start small. Find a topic that you are passionate about, learn about it, become very educated in it, and then post. But do it in a manner, like I said, where you’re not upset, because I think the posts that I’ve seen become the biggest arguments between members in groups are the ones where they’re really not responding with facts. They’re responding with emotion. So you have to take a step back from that. I give a list of things that people can do at the end of the article, as far as figuring out whether information is true or not.
Also, don’t be afraid to say, “I don’t know.” And don’t be afraid to say that you’re wrong. But being able to say “I don’t know” is so important, because I have seen so many medical professionals make a statement when they really hadn’t researched it, or it was true at the time, and then more research came out and it changed. And it’s OK to say, “You know what? This is really what I thought at the time based on the evidence, but I was wrong.” I think you gain many more followers, and people believe in you more, if you admit when you know things and also when you don’t.
Kevin Pho: My final question, Alicia: Do you have a take-home message that you want to share with the KevinMD audience?
Alicia Billington: I think that every member of our society has a duty to engage in medical advocacy: the patients, the physicians, the nurses, everyone. Health is something that affects every single citizen in the United States. It’s something that I think a lot of people find boring, or they think, “Oh, I don’t really understand it.” But I think it’s going to be a very vital component of our upcoming election, as it is in every election. I just really encourage people to go out and educate themselves on it and become involved.
I know a lot of physicians say, “I don’t have time for this,” but this is your profession. You made an oath to do no harm, but you also have to do the right thing. And I think the right thing is really advocating for your patients, and no one can do that better than you.
Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.
Alicia Billington: Thank you so much. I appreciate it.
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