Fake News! Get Your Fake News Here!

One of the top stories of 2016 is fake news. Chances are, in 2017, we will continue to fall for these fairy tales. When people think Obamacare and the Affordable Care Act are two completely different entities, we know facts can dissipate quickly.

Why are we duped so easily?

1. These stories fit into a narrative we want to believe in, reinforcing our often insular views, where the echo chamber reverberates at high frequency.
2. We digest only headlines and forward those along, not having time to fully read the stories.
3. Lack of faith in the “media” causes us to trust any headline from any source over the mainstream media.

Facebook is recognizing the large role it plays in dissemination of fake stories to the extent that it plans to roll out a new filter in Germany to begin to fight this epidemic. Here’s how you and others can combat fake news as well.

In my last post, I made the case that in medicine, we also get caught in the trap of false narratives, leading to errant diagnoses. For instance, when we jump to conclusions based on a chief complaint, don’t capture the full history and then have a diagnosis based on a premature closure bias. Or when we turn a narrative into a story that fits preconceived ideas, leading to confirmation bias.

Consider that young woman with epigastric pain at 4 in the morning with an elevated alcohol level who will “definitely have gastritis”. Yet, we miss the strong family cardiac history and the subtle ECG changes, and it turns out she’s having an acute cardiac event.

What can we do to maintain the truth in our practice and keep that faith in the social contract between physicians and patients?

1. Promote a just culture, with transparency being the standard.
   If we are not operating in a just culture, we won’t feel comfortable speaking up. Are you in an organization where you can report errors safely? Are you rewarded to report errors? Do you even know where to report errors in your organization? If not, ask the C-suite about their just culture, and begin the conversation in your group on how to keep that maintained.
2. Encourage efforts to reduce diagnostic errors.
   One hundred years ago, Ernest Codman fought for transparency in his surgical data and was kicked out of practice for wanting to follow up his surgical outcomes over time. What happens to our patients one month from now? One year from now? Do you know what your patients are up to after discharge? I don’t. Why don’t we have a report quarterly or yearly on all the patients we’ve seen individually? What was our personal readmission rate, and why were those patients readmitted? How many times did we diagnosis a patient with disease X, only to find out it was disease Y one year later? In the era where the shortstop on the Cubs knows to the inch on where he should play in the infield based on the odds of that batter hitting a curveball to that location, why do we remain data poor?
3. Bring back autopsies.
   Yes, autopsies. Laennec, the stethoscope inventor, understood the importance of making the diagnosis by physical examination. Yet, in the unfortunate era of high in hospital mortality, he was sure to confirm his monaural findings at autopsy.
4. Fight for standardization.
   If I hear someone tell me to stay away with my “cookbook medicine” one more time when talking quality, I’m going to throw the duck a l’orange recipe in their lap. Julia Child is not doing that operation for you, nor is she making the diagnosis of heart failure for you after you spent an hour taking a proper history and physical. You are a highly skilled professional who is following care standards so we can understand variation and work to improve.
5. Find ways for the EHR to work for physicians instead of working for regulatory requirements.
   Ok, this one may never happen.
6. Debrief as much as possible, and ask what went wrong.
   After someone dies, or an error, or a procedure – even if it went perfectly fine – do you talk about what happened? Bring the team together that was involved for a short huddle. What went well? What can we improve upon? Can we simply talk about what just happened?
7. Continue to understand and push for the best evidence. Evidence-based medicine remains our cornerstone.
   Follow the guidelines, but know the evidence. Don’t blindly support guidelines without understanding the rationale. Where are your sources of information? Are you following current guidelines as well as reviewing primary sources?
8. Attend quality improvement M and M conferences.
   Bring back M and M, and perhaps in QI format. Disseminate the language and steps of QI, so your team is well-versed in lean, RCA, FMEA, just culture, systems of care, standardization and run charts.
9. Cultivate a culture of continuous improvement.
   Analyze your education plan for your hospitalist group. Do you have regular educational sessions? A CME plan? Conferences? Do you bring back the information from CME activities and share with your group? Do you engage your consultants to help teach you about the latest changes in their specialty?
10. Engage in teamwork.
    We have a generator at our house. The odds are pretty good in Florida that a thunderstorm or hurricane will come through at some point. It’s nice to have that unit in place. Backup behavior, cognitive empathy and shared decision making are all essential elements in modern healthcare. Every time a pharmacist calls me to note that I forgot to renally dose, or that another antibiotic would benefit, I thank them. If we were doing it real time, together, in the room, we would continue to reduce errors and improve communication.
11. Fight pseudoscience.

We are the standard bearers for the truth. After all, truth, hence trust, keeps that social contract between physicians and patients alive. Now more than ever, we need to strengthen our ideals, particularly as we see the bedrock of reason being eroded in many other realms.