My patient Claire and I were at odds. She is 44 years old and came to my clinic for a second opinion. The diagnosis was stage 3 rectal cancer. Symptoms started with blood in the stool and quickly turned into weight loss and abdominal pain. I agreed with my previous doctor’s recommendations for surgery, radiation, and chemotherapy. She asked about mistletoe, blue scorpion venom, and infrared lamp therapy.
We talked intently for 30 minutes, but by the end of the visit she was still not convinced. It was all I could do not to follow her into the parking lot. Claire’s personal information has been changed slightly to protect confidentiality, but she was scheduled to die young from a treatable disease.
She is not abnormal. A recent survey by the Physicians Foundation found that more than half of physicians cite misinformation and disinformation as hindering their ability to care for patients. Almost 9 in 10 think it has increased over the past five years. Having worked as an oncologist and physician for 10 years, I can testify to this firsthand. Recite the latest online trends without clicking any links. Every day, I debunk “cures” promoted by wellness companies and unproven supplements promoted by social media influencers. I disentangle the mundane procedures that raise questions about political spin and reassure against hallucinatory AI chatbots that jump to the worst diagnoses.
No one has a clear solution, but most of the time the focus is on how healthcare workers communicate. Medical societies, hospitals, and even the U.S. Surgeon General are releasing toolkits and training to help people engage with people with whom they disagree. The general principle is to listen, ask questions, and respond with empathy rather than judgment.
However, these tactics assume what is clearly missing: a doctor that the patient can actually contact. It’s no coincidence that medical misinformation is among the hardest hit as access to medical professionals worsens across the country.
The average wait time to see a new doctor in the United States is now 31 days, up from 26 days in 2022 and 21 days in 2004. Once thought to be a problem of geography (rural areas) or specialty (family medicine), delays are now a staple of American medicine. I’m trying to refer a patient to a neurologist or psychiatrist, but they have appointments booked until next year. Some clinics will send me a form letter back, but the wait time is so long that I can’t even schedule one. Please try again later.
This is a full-blown crisis, but one that we have accepted, normalized, and, worst of all, misunderstood. The most common explanation cites supply and demand. There is a shortage of doctors, while patients are getting older and becoming sicker. However, it does not completely match national data. This doesn’t explain why it takes 231 days to see an obstetrician and gynecologist in Boston, where doctors are abundant. It also doesn’t capture why patients have trouble seeing their own faces. usually doctors. My own patients wait three months before seeing me.
The truth is not supply and demand, but a severe workforce mismatch where physician expertise and patient needs are mismatched. Today, the amount of bureaucracy required to advance patient care has exploded. Cluttered electronic health records require more than five hours of record-keeping for every eight hours spent with a patient. Doctors spend more than a dozen hours each week calling and writing letters to insurance companies. However, the core infrastructure for delivering this care has not yet adapted. The payment model rewards an assembly line of consecutive visits as the sole currency for medicine, compressing each into 15 minutes to pack in more.
The result is a cascading failure. A typical primary care physician has 2,500 patients and requires 27 hours per day to care for them. If your busy doctor can’t do everything, we will refer you to a specialist for issues that can be addressed in other ways. Specialists do the work of generalists. Generalists do the work of nurses. Nurses work as medical assistants. And medical assistants work with technology that works. If we consistently misallocate our time, artificial scarcity spills over into real scarcity. A record number of doctors are burnt out, going part-time or quitting medicine altogether.
Losing doctors to paperwork seems terribly solvable, but most ideas for improving access ignore this reality. Nothing will help patients by pumping more medical students into a system that chews them up and spits them out. Increasing the number of housing slots is also a dead end. Sending doctors to rural areas will not solve the nationwide problem. And expanding insurance coverage for patients is not the same as improving access. Even the best insurance does not guarantee a reservation.
The consequences are more than an inconvenience. Patients want help but are unable to receive it from professionals, so they seek help wherever they can. The winners are the scammers who clear the low bar of simply showing up. The losers are everyone else.
The silver lining to this story is that the reverse is also true. Continued access to a doctor directly increases trust in the facts. Surveys show that although Americans have lost some level of trust in medical institutions, they continue to trust their doctors as their number one source of health information. On the other hand, they maintain a healthy skepticism of others. For example, more than half of people pay attention to social media, but fewer than half trust it. If you pit a doctor you know against the most charismatic TikToker, the doctor usually wins. I was able to persuade unsure patients to get the tests and treatments they needed without using up their limited time and savings. In many cases, multiple conversations are required, but some patients are so immersed in misinformation that the conversations don’t go well. But most are not belligerent. They appreciate the clarity. They don’t like option B. If option A is not available, they settle for it.
We can and should fight outsiders to tackle junk medicine. When it comes to health, we can push for social media regulation, hold companies accountable, protect AI chatbots, and apply political pressure to public officials who are the sources of falsehoods instead of correcting them. But that’s not enough. Playing whack-a-mole against misinformation is a losing strategy when it manifests itself in other forms. Other doctors turn to social media themselves to insert good content among the bad, but that’s not the same as adapting to individual situations. Most importantly, a reliable home base for breaking records.
Healthcare organizations need to invest in creative solutions that restore the division of labor that allows doctors to see patients and patients to see doctors. Broadly speaking, these can be categorized into technology, team, and time. Technology: Fundamentally upgrading electronic health records to serve users and simplify rather than complicate physician workflows. Team: The paper shows that primary care physicians work an estimated 9.3 hours per day, 27 hours a day, in collaboration with a support team that includes nurses, nurse practitioners, social workers, and pharmacists. Finally, time: Extend time spent on patient care beyond assembly line visits, such as phone calls and patient messages, beyond fee-for-service. Implementing any of these changes will help bust myths and prioritize the doctor-patient relationship as a life-saving silver bullet.
Unfortunately, Claire died of curable cancer. I asked her to follow up, but since my first appointment was several months away, she continued to consult other sources. Instagram suggested cutting back on sugar to starve tumors. A podcast recommended Ivermectin. Politicians have expressed regret about vaccines given decades ago. I lost her due to poor access. It filled up quickly. I later learned that ChatGPT said something in the noise that was very accurate, if not completely unrealistic. “You should see a doctor.”
Ilana Yurkiewicz is a clinical associate professor of medicine and oncologist at Stanford University, and author of the following books: “Fragmented: A Doctor’s Quest to Connect America’s Healthcare.“
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