Episode #244 Battling Myths and Misinformation: Ensuring Patient Safety in Anesthesia

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. We are so excited to be talking about the February 2025 APSF Newsletter today. There are so many excellent new articles to talk about and so much more to learn when it comes to keeping patients safe during anesthesia care. So, stay tuned.

Before we dive further into the episode today, we’d like to recognize PPM, Preferred Physicians Medical Risk Retention Group, a major corporate supporter of APSF. PPM has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, PPM- we wouldn’t be able to do all that we do without you!”

We are starting our journey through the February 2025 APSF Newsletter with an article by George Tewfik and Raymond Malapero. Our featured article today is “Battling Medical Misinformation: An Important Patient Safety Issue for Health Care Professionals.” To follow along with us, head over to APSF.org and click on the Newsletter heading. First one down is the Current Issue. Then, scroll down until you get to our featured article today. I will include the link in the show notes as well. Don’t forget that the Newsletter is translated into the following languages: English, Chinese, French, Japanese, Portuguese, Spanish, Arabic, Russian, and Korean.

Before we get into the article, we are going to hear from one of the authors. Here he is now.

[Tewfik] “ Hi, my name is George Tewfik, and I am an Associate Professor of Anesthesiology and the Director of Quality Assurance at Rutgers New Jersey Medical School in Newark, New Jersey.”

[Bechtel] To kick off the show today, I asked Tewfik why he wrote this article. Let’s take a listen now.

[Tewfik] “ I wrote this article because medical disinformation is a huge problem in medicine, and it is even more acute in anesthesiology when we have a limited period of time to communicate with our patients.

It’s not uncommon to meet a patient for the first time only a few minutes before rolling back into the operating room or before beginning a procedure.  In that time, in addition to performing a focused history and physical and discussing our anesthesia plan, We have to earn a patient’s trust and provide them comfort with an anesthetic plan that often causes more anxiety than the surgical procedure itself.

This already difficult problem becomes even more complex when we are battling outside forces of misinformation.  The goal of the article is to provide education for readers regarding the issue of misinformation, and to discuss some strategies that can be used to better combat it. As well as to understand better where our patients and their families may be coming from when they bring up concerns that may sound outlandish.”

[Bechtel] I also asked Tewfik what got him interested in this topic. Here is his response.

[Tewfik] “I’ve been interested in this topic since I started hearing in residency about hesitancy to receive propofol following Michael Jackson’s death.  That was the first time I became aware of how the internet can really propagate misinformation.  And ever since the start of the pandemic, it seems to have gotten much worse.

It also does not help that there are so many more outlets for people to discuss any topic, such as TikTok, Reddit, Blue Sky, etc.  The internet seems to magnify conspiracies quickly as well. In the past, every town had the one conspiracy theorist, and no one seemed to take them very seriously. But when every town’s conspiracy theorist finds every other town’s conspiracy theorist, they can gain real momentum and potentially shape public opinion on any subject, including public health.

Then again, if we aren’t careful as healthcare practitioners, we can dismiss medical misinformation as fringe theories or silly thoughts. And if we don’t listen to our patients and work to empathize, we risk worsening a bad situation, causing even more anxiety, and ultimately leading to poor medical decision making.”

[Bechtel] Thank you so much to Tewfik for helping to kick off the show today and introduce this topic. And now, it’s time to get into the article and learn about the impact of medical misinformation on patient safety. This is a huge threat to anaesthesia patient safety given that billions of people all over the world are consuming media on Facebook, Instagram, TikTok, X (formerly Twitter), Snapchat, Pinterest, Reddit, Messenger, and YouTube. We are becoming quite dependent on these social media channels for information about politics, sports, general knowledge, and news. Did you know that according to Pew Research in 2022, adults under the age of 30 actually trust information from social media almost as much as national news outlets. In addition, in 2023 half of adults in the United States received news at least some of the time from social media. If we go back to the early days of the internet, that’s when we first begin to see medical misinformation on the internet and it has only increased since then.

Okay, now we need to highlight some important definitions. According to the United States Office of the Surgeon General, medical misinformation is “information that is false, inaccurate, or misleading according to the best available evidence at the time.” Another term that we need to understand is “Cyberchondria.” This refers to the heightened distress or anxiety caused by review of medical information on the internet. Where does this distress come from? Patients with pre-existing anxiety may seek out additional information on the internet for reassurance. Then, since this information may be unreliable, it may cause alarm and surprise, which can then cause some patients or family members to find reassurance whereas others do not. People who are not able to find reassurance may then seek out even more online health research which can produce increasing levels of anxiety and then a self-perpetuating cycle continues.

We saw the impact of medical misinformation on the public understanding of the health concerns during the COVID pandemic when it came to social distancing, mask mandates, and vaccination. The same thing happens with perioperative medicine. For example, patients presenting in labor may hesitate to consent for an epidural for analgesia if they had previously consumed medical misinformation about epidural side effects and complications. A 2022 scoping review evaluated the most common patient-reported barriers to epidural use in labor which included the following:

• Maternal side effects
• Fetal complications
• Prolonged labor
• Paralysis
• And other concerns.

Another example involves performing peripheral nerve blocks for postoperative analgesia. Patients may hesitate to consent to the block if they consumed medical misinformation on public health forums, which may not be moderated and may include personal anecdotes that can influence patients. Let’s look a little closer at this example. Do you remember the lawsuit filed by professional American football player Sharrif Floyd against renowned orthopaedic surgeon Dr. James Andrews and his colleagues. This led to heightened public concern about peripheral nerve blocks since Floyd attributed his career-ending injuries to his knee surgery and the nerve block with some embellishments or sensationalism of the story. Following this story, many patients who needed orthopaedic surgery developed fear and anxiety. It was possible to find reliable information about this case from the text of the legal complaint or the in-depth analysis in Sport Illustrated by Michael McCann. At the same time, there were many sources for medical misinformation including a Reddit page with theories about the case and an X/Twitter post with speculation and comments. These sources may appear knowledge-based, but are often quite unreliable.

There is a theme that sensationalism in the news may lead to downstream effects of patient fear and hesitancy regarding common anesthesia medications. Many anesthesia professionals have been asked about the safety of using Propofol especially after the death of Michael Jackson. Recently, there has been negative coverage of fentanyl and its use in illicit drugs that has led to questions, anxiety, and panic as well. Both of these medications can be used safely when administered by a trained anesthesia professional with proper monitoring and equipment.

Let’s take a look at Table 1 for a sample of categories of medical misinformation in Anesthesiology with frequently asked questions or statements from patients or family members. Have you been asked some of these questions? I will include this table in the show notes as well and we are going to go through it now.

The first category is Intraoperative Awareness. Sample patient and family concerns include:
“Will I wake up during surgery?”
“Please don’t let me wake up during surgery.”
“I saw a movie or TV show once, and they were awake during surgery.”

The next category is Medications given are very dangerous (including propofol, fentanyl, etc) and the concerns may be voiced as follows:
“Are you going to give me that fentanyl stuff?”
“I’ve heard that you use that stuff that killed Michael Jackson.”
“Don’t use that on me, are you trying to make me an addict?”
Matthew Perry died from ketamine. Don’t give me that.”

Our third category is Anesthesia changes postoperative behaviour with concerns that may include:
“Don’t let me say anything stupid in there.”
“Can you get seizures from anesthesia?”

Next up, we have Epidurals cause permanent damage. Concerns from patients may include the following:
“Don’t those things paralyze you?”
“I know you can get bad back pain from those things.”

Another category is Nerve blocks do not work. Patient may state:
“You just want me to have that so I don’t get any pain meds.”
“I’ve heard those things never work and can really hurt.”

Our next category is Sedation is safer compared to general anesthesia. Patient concerns may include:
“I know sedation is so much safer. Can I have that instead?”
“I’ve heard that people die undergoing general anesthesia all the time.”

And the final category is Understanding how anesthesia works with the following patient concerns:
“You don’t even know how that stuff works.”
“How do you give medications when you don’t know what it does?”

We are almost out of time for today. Before we wrap up, we are going to highlight the impact of medical misinformation on anesthesia patient safety. Let’s turn our attention to Figure 1 in the article.

Medical misinformation may cause patients to develop fear and anxiety which may lead to physiologic changes as well as non-compliance. Another downstream effect may be delayed treatment which means that the intervention may occur after the most effective time. Patient may also avoid treatment due to medical misinformation which can lead to either an untreated condition or the use of an alternative or inferior treatment modality. These are serious patient safety concerns. Next week, we will discuss the impact of medical misinformation on patient safety and what we can do about it!

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

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Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

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