SCCM Resource Library-Misinformation in Medicine in the Rural Setting

Video Transcription

Hello, my name is Carolyn Foxtall. I'm very honored to be a part of this virtual panel discussing misinformation in medicine as it pertains to the intensivist, and I'm very eager to learn from my co-presenters as well.  My piece that I'll be contributing today is providing some information and personal perspective regarding misinformation in the rural setting, as that is where I practice.  I'm a small town kid married to a farm boy, and I feel very fortunate that I'm able to raise my family here while practicing at a hospital that is able to provide comprehensive services and resources to our patient population.  Kearney is a town of about 30,000 people in central Nebraska. Of the roughly 2 million residents of Nebraska, two-thirds of them live in the Omaha and Lincoln metropolitan areas, with the remaining one-third living in what would be considered rural Nebraska.  CHI Health Good Samaritan serves a population of close to 350,000 people, and our tertiary referral center can reach up to the size of the state of Illinois based on the rural nature of our population.  Shown here are a few photos of our facilities. You can see on the left is our operating room suite, got a new roof a couple summers ago after a hailstorm. On the top right is where we get our water fresh from the Ogallala Aquifer on the daily, and at the bottom right, you can see one of our ambulances that is in use all throughout the year, except during waterfowl season when it is used for hunting.  Now, hopefully all of you have recognized this slide as misinformation, and because this is a virtual presentation, I'm going to go ahead and assume that my joke went over well and you thought it was hilarious.  Back to a more serious note, over the next few slides, I'm going to discuss some demographics in rural America and how those demographics are associated with incidents of COVID-19 infections as well as deaths related to COVID-19.  19.3% of the population, or about 60 million Americans, reside in rural America. The population in rural America tends to be older as well as sicker. As we can see in the data from the MMWR displayed on the bottom of this slide, not only are rural Americans more likely to have multiple chronic conditions, they are also more likely to die of those chronic medical conditions as compared to their metropolitan counterparts.  This is not necessarily surprising when we understand the access to healthcare disparity between rural and urban America is less than 10% of physicians practice in rural communities. Amongst primary care providers, there is about a 15% reduction in access, and with specialty care, that gap is even wider.  Additionally, rural Americans are more likely than their urban counterparts to work in a high-risk industry where face-to-face interaction is more likely to be required and remote working is less feasible or not feasible.  Case in point, Drs. Mahal and Thompson, who are on this panel with me today, saw early in the pandemic in Nebraska a large portion of cases related to meatpacking plants that came from rural communities where those plants are the main employer in the communities which they are located.  Data from the Journal of Rural Sociology comparing urban to rural counties and characteristics that pretend to increase COVID-19 cases as well as increasing death rate of COVID showed that functions of disadvantage, such as lower education level, lower socioeconomic status, and lower percentage of non-Hispanic white residents, increase both incidence and rate of death.  However, more conservative political beliefs and increased employment in high-risk industry only was associated with increased incidence and not rate of death.  Additionally, as described in the Journal of Rural Health, we can see similar characteristics associated with lower vaccination rates in rural versus urban counties in the United States.  Unfortunately, despite the data that I've shared and headlines such as these seen in the day-to-day or lay news media, misinformation pervaded and affected the decision-making of many rural Americans and certainly where I practice.  Next, I'm going to discuss some unique challenges in rural areas regarding misinformation that I've perceived.  One is a lack of local news coverage.  While our public health departments and news stations have done an excellent job reporting on the behavior of the virus in our area, it can be difficult to whittle down the data to an area small enough for it to feel relevant to a rural resident, especially relevant enough to affect behavior change.  Secondly, the role of the quote small town doc.  In many small Nebraska communities, there is only one or a handful of providers.  These providers are responsible for administrating and leading their hospitals as well as responsible for many leadership roles within their communities outside of the hospital.  Taking on the monumental task of tackling the pandemic with fewer hands to spread the word out amongst is certainly a challenge and battling misinformation is just another task to add to their list.  Thirdly, misinformation from trusted sources.  This has been a relatively infrequent occurrence.  However, I have found it evident where I practice at times.  In areas where patients have access to one or only a few medical opinions, if those opinions are spreading misinformation, it can be very hard for other providers to correct this.  And lastly, a false sense of security.  While there is a sense of security in rural areas by knowing who we are around and having relationships with many of the people around, this certainly does not apply to COVID transmission.  Next, what are some of the challenges of addressing misinformation in the intensive care unit setting?  One is time, and I don't think this is necessarily specific to the ICU, but we have certainly felt increased pressure on our time related to the volume of patients and their sheer complexity.  As well as increased time required to don and doff PPE and additional time to communicate with families who aren't able to be present at the bedside.  All of this can contribute to compassion fatigue and burnout, which may lessen our desire to address misinformation at all.  And lastly, is it the right setting?  Is confronting misinformation the most important thing right now?  Oftentimes, I feel that maintaining a trusting relationship with my patients and their family members trumps addressing misinformation, so I delay until I feel that our relationship could potentially handle that if they disagree with me.  And if they do disagree with me, am I going to fall into a rabbit hole of political buzzwords and conversation topics that I have no desire to address at work with my patients and their family members?  Here are some examples of misinformation from conversations that I've had with patients and family members in my experience.  I'm sure that all of you listening today can come up with your own lengthy list as well.  There are a variety of emotions coming across in these quotations, as well as a variety of sources of misinformation.  Although I wish I could say that I was successful in changing all of these people's minds and getting them to believe the evidence-based truth, it would be more accurate to say that I was successful in meeting them where they were at emotionally, providing evidence-based care, and maintaining a trusting relationship as their intensivist.  Lastly, I'm going to discuss some solutions and tools that we have used in our intensive care unit to combat misinformation, and I'm eager to learn of other solutions from my co-panelists as well as those listening on today.  First involves engaging administration.  This tool has been most helpful to me in the rare but concerning encounters when I learn of misinformation coming from a trusted health care provider outside of my facility.  In these awkward instances, the concern is reported to our quality officer, who then documents and follows up on the concern with the patient or family member, and then that concern is forwarded on directly to the referring provider or hospital.  In these instances, it can open up important dialogue to address misinformation.  Secondly, engaging and expanding your network.  Because the facility that I work at serves a large number of critical access hospitals, access to pulmonary or critical care doctors is not continually available to many of the primary care providers.  Thus, being available to answer questions and provide real-time experience can help to combat misinformation and provide a real idea of what's going on in our rural intensive care units.  Thirdly, engaging nursing and ancillary staff.  As these staff spend the most time with our patients, they can have a great impact on patients' and family members' knowledge as well as the knowledge base of our communities that they live in.  And lastly, taking time to prevent burnout, prevent compassion fatigue, and improve wellness among our employees as to have the energy and motivation to address misinformation that we encounter.  That concludes my presentation. I thank you all for your time and attention. I look forward to our discussion on this topic coming up.

Video Summary

In this virtual panel discussion on misinformation in medicine, Carolyn Foxtall shares her perspective on the impact of misinformation in rural areas, particularly in relation to COVID-19. She highlights the demographic characteristics and healthcare disparities in rural America, such as limited access to healthcare and higher prevalence of chronic conditions. Foxtall also discusses the challenges of addressing misinformation in the intensive care unit (ICU), including time constraints, the importance of maintaining trust with patients and families, and the need for self-care among healthcare providers. She concludes with some solutions and tools to combat misinformation, including engaging administration, expanding professional networks, involving nursing and ancillary staff, and prioritizing wellness.

Asset Subtitle

Quality and Patient Safety, Professional Development and Education, 2022

Asset Caption

This session will delve into the pervasive amount of medical misinformation that has permeated our society and how it affects the critical care medicine professional. The vast amount of misinformation that has been spread via vehicles such as social media and government officials leads to a skeptical public when medical professionals give advice on how to combat medical issues. The COVID-19 pandemic and the vaccination process will be main topics of discussion.

Meta Tag

Content Type Presentation

Knowledge Area Quality and Patient Safety

Knowledge Area Professional Development and Education

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Evidence Based Medicine

Tag Healthcare Delivery

Tag COVID-19

Year 2022

Keywords

misinformation in medicine

rural areas

COVID-19

healthcare disparities

chronic conditions

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