Category: Guest Blogs

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

A sneeze issued from the tent as we approached.

“Anybody home? Street medicine outreach,” my preceptor called out.

The tent’s mouth unzipped, the canvas falling inward to reveal our patient, a young man. Our street medicine team frequented these community campsites on a biweekly basis, providing medical care to individuals experiencing homelessness.

I knelt down, offering a cup of coffee.

“How are you today?”

Our patient shook his head.

“Not so good,” he coughed, cheeks flushed. He’d become ill yesterday; fever, malaise, sore throat, cough. Four days ago he’d had a meal at a soup kitchen–one our team knew was the site of a recent COVID-19 outbreak.

After hearing his history, I asked, “Can we get you a COVID test today?” Our patient looked up sharply. I was aware of him taking in my N-95, the pro-vaccination pin on my lanyard.

“Nah,” he said, “that COVID thing is a hoax.”

Immediately, my heart began to beat with agitation. I couldn’t ignore his provocation: the presentation of false facts, my own knowledge questioned, and, of course, the public health ramifications of his belief.

How dare he claim COVID-19 was a hoax?

A recent Kaiser Family Foundation report found that 78% of those surveyed “believed or were unsure about at least one false statement,” related to COVID-19.¹ COVID-19 misinformation has created a second pandemic; loss of trust in scientific institutions, failure to evaluate credible information, and a lack of agreement among neighbors on even the most basic set of facts. COVID-19 misinformation is “a powerfully destructive force…one false idea can spread instantly to many vulnerable ears.”²

But while it is true that misinformation is a tremendous burden to our collective public health, so too is the way we speak of those who espouse it. We shake our heads at the “ignorance,” and lament the “selfishness,” of those who eschew medical recommendations, effectively creating silos of “us” versus “them,” that pit clinicians against patients. Infrequently, however, do we attempt to understand the lure of misinformation. It is not often that we stop to consider how misinformation may make sense to those for whom our health care system has not traditionally worked well.

Our patients experiencing homelessness have good reason to mistrust health care; unhoused patients contend with profound bias, stigma, and mistreatment in medical institutions.³ So too do our patients of color; we have yet to demonstrate, in health care or society, that we value the lives of Black, Indigenous, or Latinx Americans.⁴

Misinformation results from a lack of trust in one another, a fundamental breach in our ability to communicate respectfully. Mitigating misinformation can only begin when we endeavor to understand its origins.

In her book, I Never Thought About It That Way, Mónica Guzmán makes the case for changing our approach toward those with whom we disagree. She argues for curiosity as an antidote to the partisan isolation of our current discourse. Instead of attacking one another on the merits, or perceived lack-there-of, of our arguments, our inability to communicate with one another must be the starting point to engagement.⁵

We must approach misinformation the same way.

In my own life, I have witnessed the destructive power of false belief. A close family member refused to be vaccinated for COVID-19, subsequently failing to meet my son until more than a year after his birth. I have a parent who struggles with the neurologic sequelae of long COVID-19, frequently tasked with convincing others their symptoms are real. As I try to navigate how to keep my children safe, in a world ready to move on, I meet unvaccinated patients, in clinic and on the streets, who assert that COVID-19 is fake, overblown, or a conspiracy. I am usually frustrated, occasionally devastated, and often terrified by the hold misinformation has on our communities.

But I have learned enough, from my mentors and my time working with unhoused patients, to know that building bridges back to health care and community is hard. Building trust, both within our hospital walls and at our dinner tables, on the curb or in the clinic, requires patience, grace, and yes, curiosity. Guzmán offers this advice: “When you want to stop listening so you can react or respond or judge…mind that gap between what you know and what you most certainly don’t and ask one more curious question.”⁵

We must attempt to see one another, before we try to change one another. I faced my patient and took a deep breath.

“Tell me more,” I said.

Molly is an incoming PGY-0 in the Psychiatry department at Duke University. She studied sociology and peace studies at Bryn Mawr College before serving as a Peace Corps Volunteer in Belize from 2014 to 2016. She is the co-founder of Auxocardia Journal, a creative space for health professional students, and previously served on the board of the University of Michigan Medical School’s Wolverine Street Medicine, leading foot care efforts for persons experiencing homelessness and medical education initiatives. She is a 2022-2023 Albert Schweitzer Fellow in the Detroit cohort, member of the Gold Humanism Honor Society, and AOA.

1. Hamel L, Lopes L, Kirzinger A, Sparks G, Strokes M, Bridle M. Kaiser Family Foundation COVID-19 vaccine monitor: media & misinformation. KFF Reports. 2021. Accessed March 2, 2023.

2. Nelson T, Kagan N, Critchlow C, Hillard A, Hsu A. The danger of misinformation in the COVID-19 crisis. Mo Med. 2020;117(6):510-512.

3. Reilly J, Ho I, Williamson A. A systematic review of the effect of stigma on the health of people experiencing homelessness. Health Soc Care Community. 2022;30(6):2128-2141. 4. Manning KD. More than medical mistrust. Lancet. 2020;396(10261):1481-1482. doi:10.1016/S0140-6736(20)32286-8

5. Guzmán M. I Never Thought of It That Way. 1st ed. BenBella Books; March 8, 2022.

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.

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.

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

I set the microwaved cup of instant coffee on the table so hard that it sloshes. He looks at me with guarded eyes. Despite trying to stay positive, this is not exactly an ideal start.

Working with refugees seeking asylum has taught me that trust is not easily won, and nor should it be. For someone who has lost so much to tell you their stories, it requires the willingness to try establishing a connection over and over again.

“David,* you need a root canal due to the deterioration of your teeth,” I explain the procedure to him and its importance to his health, but he shakes his head vigorously to make me understand.

“They will sell my teeth to the government. They will use it to track me down or frame me for a crime.”

David’s fears are far from unfounded. His deep mistrust of the medical system is borne from experiences in his home country, where the government arrested people for crimes they did not commit, and health care providers turned over patients to the police. His misinformed beliefs are rooted in conversations with other refugees that have warned him that people may pretend to help him only to send him back to his home country.

He has little reason to trust me after our few hours of meetings over the past few weeks. My eyes settle on his knuckles glowing white as he clutches the coffee cup.

I soften my voice. “I know it is scary. This procedure is completely safe. All they will do is…”

He cuts me off, exclaiming in frustration. “No! Too many words! I don’t want it, I told you.”

Instead of immediately responding, I take a moment. My mind wanders to my niece, remembering her eyes brimming with tears as she screamed that she didn’t want to go to the dentist because it would hurt. We showed her a video, explaining what each tool did until her tears subsided. Maybe combating misinformation isn’t just the information itself but finding the best way to communicate it to the other person.

I pull up a video on YouTube that explains the procedure. I watch as his tense shoulders relax, smoothing into gentle curves just as the frown of his lips settles.

I ask a little too cheerfully, “So… what do you think?”

He looks at me for a moment. He is still unsure, but I can see his grip on the Styrofoam cup loosening. I allow myself a moment to hope.

“Not today, I think.” He hitches his jacket over his shoulder as he prepares to leave the appointment. I feel the familiar stone of disappointment settle in my stomach as I shuffle the stack of papers stained with coffee.

He pauses at the door. “Next week? Next week we can watch the video again?” he asks.

I smile wider. Nod. “We can watch again next week. Maybe I’ll even write a song to convince you.” David nods back at me. Not exactly a smile, but an affirmation we will try again next week. And the week after. And as many weeks as he will let me try to earn his trust.

Misinformation is a door that offers a peek into the corners of another person’s mind. Although these conversations may be fraught with tension and disagreement, they are also an opportunity to understand more deeply. Building trust is a series of small steps that do not always arrive at a solution. Although it may not have the outcome I hope for, it is still as valuable as an appointment where mutual trust comes quickly.

I believe the most difficult piece is accepting that agreement is not always promised. My first months of medical school were energized with idealism and the belief I could win over every patient. Now, I have a more subdued approach. I sit beside the patients. I listen without judgment. I wonder about the amalgamation of life experiences that have led them to their beliefs, ingrained value systems, and this very conversation.

I do not pretend to have all the answers. Perhaps this is ultimately what draws us together. Even at odds, reaching out to each other across a vast divide, we can all acknowledge that we are doing our best to find meaning amidst the messy beats of life. So that even if our conversation does not end with agreement and a handshake, there is a promise to keep reaching across the divide, listening and sharing thoughts over a lukewarm cup of coffee.

Meher Kalkat is a third-year student at the Johns Hopkins School of Medicine and is originally from West Palm Beach, Florida. She is passionate about medical education, physician and trainee wellness, and combating mental health stigma. In her free time, she loves to sing karaoke, bake, and take photographs.

*Note that name and any identifying information have been changed.

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

“Are you sure?” The question was to my preceptor, but his gaze was on me, like he was searching for a second, differing opinion.

If we’re being honest, I’m usually not sure. The abundance of information available at our fingertips can be overwhelming. As a first-year medical student, I often struggle to trust myself, but I trust the process of my training. Since starting my pre-clinical years, my knowledge base has been tested, stretched, and built upon at an exceeding rate. Every other Tuesday, I get to see real patients, practice interview skills, and apply new material through a clinical preceptorship program. It’s in these clinical encounters that I learn about more than the organ system of the block. It’s in these clinical encounters that I witness fear and vulnerability turn into trust. It was also in one of these clinical encounters that I met Sergio.

Sergio was a year younger than me. A week prior he was helping a neighbor with a construction project where he inhaled some dust and debris. The exposure was brief and limited, but he was nonetheless concerned. He read online that vigorous exercise was the best thing he could do to “clean out his lungs following exposure.” Not only did it not help, but for the first time in years, it exacerbated his asthma. The next day, he noticed a new pain in his back right where his lung would be. He came to us anxious and convinced that lung scarring from the exposure would lead to a serious disease. As my preceptor worked through his list of concerns, reassuring him along the way, he’d push back.

“Yes, I understand, but…” he’d circle back to something else he read. It’s pulled up on his phone. He can show us.

The issue with online information is that it’s often out of context. Internet searches tend to identify rare or worst-case outcomes. Misinformation and misinterpretation often go hand-in-hand, and it’s hard to navigate this space alone. Caring for vulnerable patients requires trust, comfort, and thoughtful communication to help alleviate the anxiety often experienced by patients in these settings. Teachable moments in the clinic are an opportunity for these values to shine.

My preceptor is good at teachable moments. I’ve watched her pull up diagrams on her computer to show patients exactly what she is talking about when referring to anatomy. With Sergio, I watched her do what his online searches couldn’t. I followed along as she connected his medical history, experience, and story to his current symptoms. I listened as she walked us through her line of thinking.

We found out that he’s not usually that active and swinging a hammer in that manner was a new motion for his body. Most importantly, we were able to pinpoint a muscle group that aligned with where he felt the pain. To his relief, it wasn’t his lung.

We no longer have a stronghold on medical information, but we have the skills of empathy, connection, and context. The ability to assess, interpret, and contextualize signs and symptoms is a gift. For Sergio, it provided the reassurance he desperately needed in that moment. The amount of information available online can be overwhelming, but teachable moments can build trust for medical students and patients alike. It’s moments like this that engage patients in their own care and rebuild the foundation of trust and partnership.

Elina Kurkurina is a first-year medical student at the Frank H. Netter MD School of Medicine at Quinnipiac University. She is interested in the intersection between emergency medicine, geriatrics, and primary care. Prior to medical school, she worked in quality measurement and holds an MPH degree in Social and Behavioral Sciences from the Yale School of Public Health. In her free time, she can be found on a hiking trail with her husband and rescue dog. 

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 the tip of the syringe moved toward his shoulder, I witnessed an ever-expanding fear grow in the eyes of Teddy, a 6’ 6”, 260-pound Police Officer at New York City Health + Hospitals (NYC H+H), in Harlem.

Teddy, a Harlem native, was supported, loved, and grew up in the surrounding community, and he now returns the favor every day, taking care of his community in a space meant to be safe. As the needle pierced his skin, its protective contents pushed into his body, he immediately looked at me. Teddy asked me to be with him for his first COVID-19 vaccination. Seeing doubt and fear in his eyes, questioning what he had just done, was, for lack of a better word, painful. However, Teddy receiving that life-saving (for many) vaccine, trusting what he was taught, and relying on the information he learned, was motivating.

When I reflect on this moment, I feel somewhat selfish and uncomfortable with what I describe as a feeling of personal victory. I convinced Teddy to get his first COVID-19 vaccine! But then I remember who Teddy is, and why his decision to get vaccinated is so important to me.

Teddy was born and raised in Harlem, a permanent resident of the “Black Mecca,” a loving husband, and a proud father. During COVID-19 first wave, he was a transporter of lives lost, stored in refrigerated containers due to a lack of space in the morgue. Throughout the pandemic, Teddy was steadfast in protecting his community, a pillar in his post, often unmasked due to the limited availability of N-95’s. As a health care worker (HCW), his risk of testing positive for COVID-19 is 11.6 times higher than the general community, and as a Black male, he is 2.1 times more likely to be hospitalized due to COVID, and 1.6 times more likely to die from COVID-19 compared to white, non-Hispanic persons. Teddy was also one of 542 HCW’s at NYC H+H/Harlem who took part in the Community Activation Model: COVID-19 Vaccine Educational Seminar (CAM). Teddy getting that vaccine was a victory!

On August 16^th, 2021, New York Governor Andrew Cuomo announced that all HCW’s in the state must be vaccinated against COVID-19 by September 27^th, 2021. This preventative measure was needed due to a growing deficit in HCW availability, combined with hospitals being overwhelmed by the influx of non-COVID-19 patients due to delayed care, compounded by the Delta Variant spreading across the City. For systems like NYC H+H, where approximately 20% of its 42,000 employees had yet to receive their first vaccine, meeting this requirement would be no small task.

After my third year of medical school, I took a gap year to work at NYC H+H, and was part of a team responsible for reducing the potential downstream impacts of this mandate on the care we provide. A majority of my work was completed at NYC H+H/Harlem, where 22% of the workforce was unvaccinated.

Alongside other efforts I developed the CAM as an intervention to retain employees and to increase vaccination rates among the workforce. The foundation of the CAM is centered on respecting the individuality and unique needs of the population you seek to serve. Therefore, as part of designing the CAM, we conducted key informant interviews with hospital staff, in order to identify key drivers of vaccine hesitancy at NYC H+H/Harlem, which included:

1. Lack of trust in the vaccine due to difficulty in accessing information that is easy to understand.
2. COVID-19 no longer being a threat – “we lived through the first two waves without a vaccine.”
3. The importance of personal agency – disregard for autonomous decision making.

Respecting the unique needs of the Harlem community, I designed a teaching curriculum to answer the questions and concerns related to the population, and provide accurate knowledge to enable informed decision making. Simplifying immunology, virology, and vaccine history and development to a middle school reading level, and requiring every unvaccinated employee to take part in the seminar over a 3-week period.

The results were tremendous, with a reduction in unvaccinated employees by September 27 from 22% to 4.4% (NYC H+H average of 7.8%).

While I recognize the mandate as a critical driver of vaccine adherence, the efforts of the CAM played a major role in vaccine understanding, comfortability, and acceptance. While misinformation will always have an enormous impact on healthy and informed decision making, we learned through this experience that it is just as important to increase accessibility to understandable and accurate information that anyone can use to combat misinformation.

Dr. Christopher R. B. Montgomery’s professional journey has spanned various roles and responsibilities. After serving as Assistant Health Care Program Planner and Analyst at NYC Health + Hospitals, he is now an intern at the UCLA Reagan/Olive View Emergency Medicine Residency. His academic journey began in Germany, where he received a Baccalaureate of Science from the University of Mainz and a Bachelor’s degree in Biology from the Technical University of Kaiserslautern. He then pursued an MD with distinction from the University of California, San Francisco, preceded by a Master’s in Public Health with a focus on Global Health, Epidemiology, and Biostatistics at Loma Linda University. His experience extends to the San Bernardino Department of Public Health, where he worked as an epidemiologist, contributing to systems improvement, resource optimization and community engagement.

• Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, Mehta RS, Warner ET, Sikavi DR, Lo CH, Kwon S, Song M, Mucci LA, Stampfer MJ, Willett WC, Eliassen AH, Hart JE, Chavarro JE, Rich-Edwards JW, Davies R, Capdevila J, Lee KA, Lochlainn MN, Varsavsky T, Sudre CH, Cardoso MJ, Wolf J, Spector TD, Ourselin S, Steves CJ, Chan AT; COronavirus Pandemic Epidemiology Consortium. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020 Sep;5(9):e475-e483. doi: 10.1016/S2468-2667(20)30164-X. Epub 2020 Jul 31. PMID: 32745512; PMCID: PMC7491202.
• CDC (2022, December 28). Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity. CDC Center for Disease Control and Prevention. Retrieved March 1, 2023, from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

As medicine becomes politicized, trust in our physicians matters more than ever. High professional standards help them earn it.

“How can I find a doctor I can trust?” I keep hearing this question—from those feeling confused about a vaccination decision to those looking for an ob/gyn who shares their personal values. There’s unprecedented angst, uncertainty, and mistrust. During two decades as a patient and citizen advocate, I’ve encountered the mistrust that arises when systems that are supposed to protect us cause harm. I’ve learned that trust is an asset our health system cannot do without. It is at the heart of our relationships with our physicians and care teams and an essential foundation for the institution of medicine. Yet as our social fabric continues to fray, even the most trusted relationships come under strain. Our relationships with our physicians feel more fragile when the practice of medicine is politicized, and misinformation compounds our uncertainty and confusion about our health choices. 

As an independent volunteer public (non-physician) member of the Board of Directors of ABMS (the American Board of Medical Specialties), a nonprofit organization that oversees the standards for physician certification across 24 medical specialties (the American Osteopathic Association is another), I have a window into what happens inside the network of institutions that oversee the practice of medicine in the United States. The medical profession is dealing with its own trust challenges as it negotiates the tensions between freedom, regulation, and professionalism. In recent months, certifying boards have taken further steps to uphold their accountability by addressing unprofessional behavior and pledging to withdraw or deny certification to physicians who publicly share information that is directly contrary to the prevailing medical evidence.

While some physicians are uniting to defend their ability to take care of their patients and protect those patients’ reproductive freedom and bodily autonomy, others are asserting a questionable freedom to prescribe unproven treatments or disseminate misinformation that leads to medical harm or death. Some physicians are rejecting the institutions that enact and enforce standards of performance and conduct and oversee physicians’ accountability to the public. Efforts by these institutions to overcome mistrust should be welcomed. Self-regulation is a privilege that makes physicians accountable to their peers and importantly, the public. It is grounded in a set of agreed-upon standards and behaviors based on a common set of values and ethical commitments. It represents a social contract between physicians and the community that includes a promise to put the interests of patients first. 

But when mistrust in institutions manifests itself as legislative interference in that professional self-regulation, the politicization of the practice of medicine becomes an assault on medicine itself. The assault is already happening in states where state legislatures have told the state boards that license and regulate physicians that they may not take disciplinary action against physicians who disseminate misinformation or disinformation about COVID-19, vaccination, or scientifically valid treatments. The effects are harmful to physicians, nurses, and patients alike. In some states, physicians no longer have the freedom to provide the care they are trained to provide.

As patients, we are left wondering who we can turn to as trusted navigators as we make sense of our medical choices. As medicine becomes politicized, the answer to that initial question “How can I find a doctor I can trust?” is not as simple as reading patient reviews or going to a top-rated hospital. It’s important to know how to recognize a physician who has gone through rigorous and objective assessment of their knowledge, skills, judgment, and competencies.

The fourteen years I spent with the nonprofit Consumer Reports taught me to recognize a rigorous testing process and the ways it helps to build trust. That rigor is critical for the process of physician board certification. I’ve been reassured to find it at the American Board of Medical Specialties and its member boards: the research underlying every step, the collaborative process of standard-setting, the scientific methods that inform assessments, the secure examinations, the evaluation of ethics and professionalism, the verification that a physician is clear of any professional wrongdoing, the requirement to contribute to improving health and health care, and the cycles of continuing certification to stay current and maintain competency throughout a physician’s career. As a result, specialty board certification is one of the strongest signals that we can trust our physician. It represents a commitment to both learning and accountability.

Patients choosing a physician for themselves or loved ones would be wise to check online if a physician is currently board-certified. But if we want to help build a culture of trust in medicine, based on facts and not ideology, there are things we need to do as citizens to push back against the assault on the medical profession as well. We can communicate our support to elected representatives and candidates who oppose legislative interference in the practice of medicine and its self-regulation. As civic-minded community members, we can ask to be appointed as “public members” of the state boards that regulate medical practice or join a local hospital board as an advocate for patient safety and physician wellbeing. We can run for school boards where we can participate as champions of science education and children’s health. Civic engagement is as critical for building trust in medicine as it is for strengthening our democracy.

The ABIM Foundation’s Building Trust initiative is bringing attention to the need for greater trust in relationships throughout health care, including trust in organizations. The initiative has created a repository of trust-building examples, all conducted at the meso or macro level of organizations and made possible by some level of organizational sponsorship (whether it be financial support or buy-in from the leadership team).

We would like to call attention to organizational trust-building at the micro level, which can be initiated by anyone, requires no extra resources, and can take place within existing work structures and processes. All that’s required is a bit of awareness, intention, and courage.

Trust building at the micro-level is all about creating culture. Whether we are aware of it or not, we are all creating culture in every moment by the way we treat each other as we do our work. Culture is the aggregate of what happens in all the little moments of every day.

The phrase “whether we are aware of it or not” makes a crucial point. If we are not aware of and intentional about relationships, problematic patterns – and toxic cultures – can arise accidentally. Consider, for example, a scenario in which an honest misunderstanding or a problem that crops up suddenly causes tension and anxiety, resulting in some some harsh words being spoken. Others observe this and out of friendship or loyalty they take sides. Before long, there is a pattern of conflict – us versus them – that draws people into it and keeps itself going, sometimes for years after the initiating event. The fact that no one intended this to happen doesn’t matter; the damage is done. In the absence of active ongoing attention to the quality of relationships, a bad pattern has been established and performance will suffer.

It is extraordinarily rare for a problematic culture to be created deliberately. Almost always it results from neglect – a lack of awareness, a lack of active tending.

Now replay that scenario, this time with an awareness of relational quality and an intention to maintain trust and respect. The harsh words might be toned down or retracted with an apology after a moment’s reflection. The recipient of those words or a bystander, recognizing the underlying anxiety, might offer some empathy to help everyone feel supported and to lower the emotional temperature. With these small actions, delivered intentionally to maintain trust, the group can avoid a long-standing conflict that would likely sap commitment and divert energy from the real work.

We all have the power to be intentional about the kinds of relational patterns we create and our direct contributions to organizational culture. More than that, we can encourage and help others to learn how to do it, too. One step higher, organizations can encourage a culture of trust through recruitment, selection, and onboarding processes that favor emotional intelligence; equitable values and practices; individual and team development programs; meeting practices that encourage inclusivity, psychological safety, reflection and dialog; and meaningful behavioral standards and accountability processes.

Even as these organizational interventions can help us become more heedful and skillful, the ultimate responsibility for culture always remains in our hands. It’s about what we do in every moment. There’s much to gain and no extra work if we can approach each interaction with an awareness of relationships and the intention to create trust.

A substantial early-bird discount is available for registrations received by December 23, 2022.  

In the winter of 2020, during the height of the COVID-19 pandemic, “Ava” presented via video visit for our appointment. Ava and I are similar in several ways. We are both Black women in our 30s, and neither of us have children, although I was starting to think about the possibility. As we wrapped up the appointment, she asked a seemingly routine question about the safety of the recently approved COVID-19 vaccines. I was acutely aware of my position as a trustworthy bearer of medical news, which I was afforded due to my racial congruence to the patient. I had given my response countless times and immediately launched into my spiel – the vaccine is safe, has been tested on many people and will protect you from a severe infection, hospitalization, ventilator or death.

She then asked a question that made me pause. She had heard that getting the vaccine could impact her future fertility. She worried it would be hard to get pregnant and that she would need assistance.

I did not expect this question, so it caught me off guard. I fell silent, and hesitated to respond. Several thoughts ran through my head at that moment. I had not specifically considered the implications of the vaccine on future fertility. Nor had I heard this discussed in my clinical circles or read data deterring women of childbearing age from getting the vaccine. Since the vaccines were so new, how could I definitively state that they would not impact her fertility? There was also an earned mistrust in medicine in the Black community. She and I are from a vulnerable population and she was already skeptical of the medical system. I did not want to do anything that would make her hesitate more. 

My pause continued, verging on uncomfortable silence. I finally informed her of my plans for vaccination, and that there was no data that I was aware of linking them to decreased fertility. I knew right away that she could sense my hesitation. Her body language and facial expressions clearly showed that she knew I was not as confident in that recommendation as I had been when initially discussing the vaccine. It was a fleeting moment, but I knew I had squandered the opportunity to provide sound guidance that would impact her decision about the vaccine. I felt disappointment and sadness. She declined the vaccine that day and continued to decline it until several family members fell ill and she wanted to travel.

When I reflect on that encounter, I cannot help but feel as though my hesitation somehow played a role in Ava delaying the vaccine. This was a moment lost, a space that clinicians will experience throughout their careers. It does not feel good and yet there are valid reasons why we have those pauses. I know as a trusted medical professional that there are real consequences when we hesitate and I do not take the responsibility lightly.

Dr. Adetoye is an Assistant Professor in the Department of Family Medicine at the University of Michigan. She attended medical school at Michigan State University and completed a residency in Family Medicine at the University of Michigan.

For many, the COVID-19 pandemic has illustrated up close and personal how misinformation can spread rapidly in underserved communities. One story in particular sticks out for me when I think of this notion.

I am a practicing internal medicine physician at a community health center on the south side of Chicago. Last year, I treated a middle-aged woman who, after her fourth discussion with me, decided to get a COVID-19 vaccine. She was relieved and excited about finally being protected as best as she could be, and I was relieved as well, as she has serious chronic conditions including diabetes and hypertension. She received her vaccination and went on her way.

Several days later, I saw her name show up on my schedule and I was not sure why. I gave her a call and she began to describe the symptoms that started the evening after receiving her vaccination – including abdominal pain, loose stool, and nausea. She denied fever, chills, or upper respiratory symptoms. I asked her to come in to my office as soon as she could that morning. She appeared to be dehydrated, but otherwise her exam was normal. I asked her questions about the history and onset of her symptoms and then I asked her: “What did you eat after getting your vaccine?”

She told me that she went out to celebrate and had raw oysters and fish. As soon as her symptoms started, she believed that it was all due to the vaccine. She told her family and a dozen or so friends, and posted on social media about her experience – how the vaccine “made her sick” and was not safe.

Based on her history, exam, and labs, I let her know that she had symptoms from a virus caused by food poisoning and not from the vaccine. We then discussed trust, misinformation, and jumping to conclusions, and how all three can have a vast impact on a community. Her loved ones, friends, and followers trust her and believe her experiences to be true. I validated her fears and concerns about the misinformation that she had already spread, and then reinforced the importance of talking with your health care team about symptoms and all of the medical possibilities related to those symptoms before spreading information so widely.  

As a result of that experience, I have had similar discussions with most of my patients about the harms of misinformation, and I’ve reinforced the importance of contacting me before attributing symptoms to the COVID-19 vaccine. I provide my phone number and email to each and every one of my patients so they know how to get ahold of me.

Within six months of instituting this new practice that helps build trust and stop misinformation, I received two dozen calls from patients who needed someone they trusted to turn to in times of vulnerability and uncertainty.

Americans spend 145 minutes daily on social media, where false information spreads about six times faster than the truth.[1] We need to curb this epidemic of misinformation and it will take all of us working together to do so.

Dr. Jay Bhatt is a primary care physician in community health centers in Chicago, and co-founder and on the leadership team of #ThisIsOurShot – an initiative to bring credible and trusted information from clinicians to communities to increase vaccinations. He is also Executive Director of the Deloitte Health Equity Institute.

[1] 1. Daily social media usage worldwide. Statista. 2022; Accessed Jun 22, 2022. https://www.statista.com/statistics/433871/daily-social-media-usageworldwide/#:~:text=Currently%2C%20the%20country%20with%20the.