Author: Ian Jaffe
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
“So, do I not need to start the Metformin?” Mr. Smith1 asked a few minutes into our visit.
The question should have raised a red flag, but in my initial confusion, I asked, “What do you mean?”
“Well, I’ve been taking GlucoBal2 for four weeks, so I shouldn’t need to start Metformin, right?”
Mr. Smith explained that he’d gone home after his last visit and, naturally, had Googled “type 2 diabetes”—the disease he’d been told he had. Just as his doctor had told him, he read that diabetes was a disease in which his body could not process sugar correctly. He remembered the doctor saying that while he needed to start Metformin to get his blood sugar under control, it would not cure his diabetes.
But there had to be a cure, right? He remembered hearing something about a cure for diabetes on the news. “Cure for diabetes,” he searched. On the first page of results, he found what he was looking for: “Best Natural Blood Sugar Cure? – New Study Says ‘Try GlucoBal.’”
The website was slick, with high-quality, scientific-appearing diagrams and links to real scientific studies. It said that the blend of “earth-grown herbs and natural compounds work together to restore healthy blood sugar levels.” A natural cure for diabetes had to be better than taking Metformin forever, right? Reviews on the website near-universally said that GlucoBal had balanced people’s blood sugar. He even clicked on one of the linked studies. It seemed to support what the website was claiming. There wasn’t any need to pick up the Metformin from the pharmacy.
As Mr. Smith recounted this story, I looked up GlucoBal and its ingredients. Bitter gourd extract? Clinical trials didn’t seem to support its use.3 Cinnamon? There was some evidence it would lower blood sugar, but certainly not cure diabetes (and the dose was too low anyway).4 The rest of the ingredients fit the same bill.
“Where am I even going to start?” I thought.
I wish I could say I had some magical approach to answering Mr. Smith’s question that conveyed all my doubts after a few quick searches.
I tried to imagine what he was thinking. He had spent a significant amount of time reading about this supplement. And he had spent money too: almost $50 for a month’s supply. What could I say?
I started with a confession: “I’ll admit haven’t heard of GlucoBal, but I am skeptical of some of the claims. Lots of people have been trying to find a cure for diabetes, but nothing I’ve heard of has come close. It would be big news if something did. Would you be willing to search for some answers together right now?”
Mr. Smith agreed, and we spent 15 minutes going through the ingredients and data together. As a medical student, I had the luxury of time, with no patients in the lobby waiting for me to get to them.
In the end, Mr. Smith said he understood that Metformin was “probably” a better choice and told me that he would pick up his prescription from the pharmacy. He did.
I’ve since wondered why Mr. Smith came to trust me enough to fill his prescription. I think the time that I spent with him factors into it. After all, it’s much easier to combat two hours’ worth of internet misinformation in 15 minutes than it is in five. These days, many primary care doctors are lucky to get 15 minutes for an entire appointment.
But I think the more important element is the fact that I expressed my lack of certainty to Mr. Smith.
At the end of my medicine clerkship, one of my physician mentors gifted me some light reading: a 500-page biography of William Osler.5 I often find myself returning to this book and the writings of the eternally quotable Osler.
Reflecting on my time with Mr. Smith, one quote comes to mind: “To confess ignorance is often wiser than to beat about the bush with a hypothetical diagnosis.”6 Or, distilled: Be honest, even if it requires the vulnerability of saying “I don’t know, but let’s find out.”
As uncomfortable as it may feel to internalize this concept, it is vital for our medical training. We will all have our Mr. Smith, and we all must eventually learn to confess ignorance just as readily as we confess expertise. Honesty is the only cure for misinformation.
That only leaves us the challenge of finding the time.
Ian S. Jaffe is an MD/MS student at New York University. He currently works with the NYU Transplant Institute and is passionate about improving the health and wellness of transplant recipients. Outside of medicine, Ian enjoys cycling, writing, and exploring the museums and theaters of NYC.
1 Mr. Smith is a pseudonym.
2 GlucoBal is a fictional name for a real-life product used by Mr. Smith. There are multiple supplements on the market with similar ingredients that make similar claims and show up in similar internet searches.
3 Ooi, C. P., Yassin, Z., & Hamid, T. A. (2012). Momordica charantia for type 2 diabetes mellitus. Cochrane database of systematic reviews, (8).
4 Allen, R. W., Schwartzman, E., Baker, W. L., Coleman, C. I., & Phung, O. J. (2013). Cinnamon use in type 2 diabetes: an updated systematic review and meta-analysis. The Annals of Family Medicine, 11(5), 452-459.
5 Bliss, M. (1999). William Osler: A life in medicine. Oxford University Press.
6 Osler, W., & Camac, C. N. B. (1905). Counsels and ideals from the writings of William Osler. Oxford: H. Frowde.