Author: Isra Hasnain

Your mind matters, too

Posted June 06, 2023

The 2023 Building Trust Essay Contest, sponsored by The American Medical Student Association and the ABIM Foundation, asked medical students to engage in a reflective writing exercise about their experiences where they or someone they know received, shared, or acted upon misinformation in a health care setting

As patient advocates, physicians are in unique positions to address their patients’ concerns while also learning the belief systems that govern their lifestyle choices. To achieve this, establishing trust and reliability is an integral part of a successful therapeutic relationship. Some patients may not feel comfortable disclosing their viewpoints or collaborating with a provider who appears unapproachable and callous. If a patient is not invited to engage, indicate understanding, or provide context, there is the risk of incorrect adherence or fulfillment of the treatment plan that was developed. Misinformation can be easily overlooked if there is no opportunity to discuss it.

A particular experience comes to mind when reflecting on misinformation in health care settings. During my third year of medical school, I spent some time in a geriatric primary care clinic. One patient in her 80s, Ms. Marshall, was being seen for a routine checkup.  Together she and the attending physician discussed her hypertension, diabetes, and cholesterol. The conversation then approached mental wellbeing. The physician inquired about her mood.

Ms. Marshall looked momentarily taken aback before saying, “Actually, I just feel so anxious all the time. I don’t feel myself. I worry about everything. It’s constant.”

The physician paused her documentation to turn to Ms. Marshall. “Tell me more.”

Ms. Marshall revealed that lately, she had been worrying about her children and grandchildren more than usual for no apparent reason. She felt as though she was the caretaker of the family and always owed them her undivided attention.

“It sounds like you’ve been struggling. There are options we can talk about,” said the physician. “Therapy, medication…“

“No. I don’t want medication,” she interrupted. Her response was firm and immediate, and I saw the attending’s head tilt in concern.

“Why don’t you want medication?”

“I read on Facebook that it changes your personality,” Ms. Marshall replied. Her hands trembled in her lap. My attending gently reached over to pry Ms. Marshall’s hands apart and hold them in her own. “And makes you crazy. I don’t want to mess with anything. I’m not weak. I can handle it. I don’t need meds.”

I watched my attending pause to digest this information. This was a delicate moment. It was clear that Ms. Marshall trusted her physician enough to disclose personal matters about her mental health, but not enough to permit the physician’s recommendations to overtake her belief systems. The path forward hinged on whether or not my attending chose to acknowledge her patient’s beliefs about anxiolytic medications.

She did. “Let me ask you something,” said the physician. She was still holding the patient’s hands. “Do you take medication for your high blood pressure and diabetes?”

A bewildered pause. “Yes, of course.”

“Do you believe those medications are helping you get better?”

“I do…”

“Did you hesitate to start medication for those issues?”

Ms. Marshall was silent, as if she began to understand the direction. “No, I suppose I didn’t.”

“Then why,” asked my attending, “should your mental health be any different? Why should you treat it differently, less urgently, than your diabetes or blood pressure?”

What followed was one of the most impactful moments I can remember in my third year. I can still vividly recall the change in Ms. Marshall’s expression as she registered those words. It was as if a veil had physically lifted and understanding dawned on her face. She began to cry.

“You’re right,” she whispered. “I don’t know why I thought that. It won’t make me weak.”

In this instance, the physician was able to combat both stigma as well as misinformation. To me, this represented the importance of shared decision-making as a tool for addressing misinformation. It is important that healthcare providers present multiple options to patients to elicit their preferences as well as hesitations. Sometimes, it can be as simple as reframing patients’ priorities (“Is anxiety any different from hypertension as a medical concern?”) or probing deeper into patients’ views to create space for education (“What’s your understanding of what antidepressants do to the body?”).

Clinicians can unknowingly contribute to the spread of misinformation by not allowing space to have these critical discussions, by keeping treatment options monochromatic and inflexible, and by choosing not to explore patients’ inner lives and what helps them make decisions.

It was heartwarming to see that not only did Ms. Marshall elect to receive care for an important issue, but she may eventually correct someone else in her life who shared her former perspectives. Meaningful conversations with individual patients can make a large, perpetual impact on the health of large populations.

Isra Hasnain is currently a third-year medical student at the University of Chicago Pritzker School of Medicine. Her interests include primary care, maternal health equity, and rural health disparities. When she’s not championing her unbiased love for Chicago pizza, Isra enjoys practicing yoga and snuggling with her oreo-colored cat Nova.