Episode #245 Unmasking Medical Misinformation

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. Last week, we started the discussion about the prevalence of medical misinformation. This is a big threat to anesthesia patient safety and we are continuing the conversation today. Stay tuned so that you will be ready to respond with empathy and compassion the next time a patient asks you, “Will I wake up during surgery?”

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

We started our journey through the February 2025 APSF Newsletter last week and we are returning to the same article today for the exciting conclusion to our series on medical misinformation. Our featured article is “Battling Medical Misinformation: An Important Patient Safety Issue for Health Care Professionals” by George Tewfik and Raymond Malapero. 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.

Last week, we talked about the scope of the problem since billions of people all over the world are consuming media on Facebook, Instagram, TikTok, X (formerly Twitter), Snapchat, Pinterest, Reddit, Messenger, and YouTube. Plus, people trust information from social media and receive their news from social media channels. Remember, 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.” We talked about the impact of medical misinformation during the COVID pandemic as well as during the perioperative period when it comes to epidurals for labour analgesia, safety of common anaesthetic medications including propofol, fentanyl, and ketamine, the use of peripheral nerve blocks for postoperative analgesia and more. Many questions that patients ask prior to anaesthesia and surgery stem from medial misinformation.

This week, we are picking up right where we left off by highlighting the impact of medical misinformation on patient safety and providing some action items going forward. Medical misinformation is a threat to anaesthesia patient safety throughout the perioperative period. The authors group the negative effects into three categories in Figure 1 in the article. I will include this figure in the show notes as well. The three categories are:

• Fear and anxiety
• Delay of treatment
• Avoidance of treatment

Let’s take a closer look at each of these categories. When patient develop fear and anxiety due to medical misinformation, this may cause psychological distress which may lead to perseveration on concerns, gastrointestinal upset, sleep loss, and more. There may also be associated physiologic changes in blood pressure and heart rate. The combination of physical and psychological effects may contribute to patient noncompliance as well.

The next category is delay in treatment. Let’s take a look at an example of a patient who refuses neuraxial anaesthesia due to fear of labour epidurals that started from medical misinformation. This may lead to a last-minute request for epidural analgesia as the baby is about to deliver which may mean that the anaesthesia professional experiences significant time-pressure to get the epidural in on an actively contracting patient. Another important consideration is the increased risk in complications pregnancies. For example, patients with preeclampsia may be encouraged to have early epidural placement to help minimize the need for general anaesthesia in case there is an emergent caesarean delivery. Medical misinformation is a threat to peripartum safety if it leads to a delay in treatment and prevents safe and effective epidural use.

The third category is avoidance of treatment which may have an impact on perioperative patient safety and entire clinical course. Let’s looks at the example of a patient with pulmonary comorbidities who refuses to receive a regional anaesthetic nerve block due to misinformation about the risk of paralysis, local anaesthetic toxicity, or the block not working. Keep in mind that this is a threat to patient safety since it means that the patient cannot have the most optimal perioperative care given their comorbidities. The patient’s pain is then treated with opioids which results in the potential for respiratory depression, airway obstruction, delayed discharge and further complications. If we return to the maternity ward, patients who refuse to have a labour epidural may experience severe labour pain that remains untreated with the potential to develop acute stress or even post-traumatic stress disorder from their experience during the peripartum period.

Now, it’s time to talk about what anaesthesia professionals can do to keep patients safe in the face of medical misinformation. The first step is to increase awareness of the impact of medical misinformation. So, just listening to this podcast and reading the APSF article is a great first step. Keep in mind that when patients ask questions such as “Will I wake up during surgery?” or “Don’t epidurals mess up your back forever?” these may not be random, fleeting questions. These questions may stem from significant anxiety caused by misinformation. Perhaps, a friend or family member shared an anxiety-producing video from YouTube or a post on Facebook before a planned surgical procedure or anticipated labour and delivery. Even though these concerns stem from incorrect information or irrational concerns, patients may suffer continued anxiety and stress if these questions are not answered in a compassionate and thoughtful manner.

This is the next actionable step for anaesthesia professionals: demonstrate empathy and compassion for a patient. Avoid being dismissive of these concerns. Here are some ideas for what we can say when patients bring up these concerns.

• “I’m sure this process can be very scary.”
• I understand you have some concerns; let’s discuss them further.”

The authors highlight this critical step. When anaesthesia professionals are able to validate their patient’s fear instead of dismissing their concerns as being unreasonable, this plays an important role in attenuating that fear and establishing trust between the clinician and the patient. Anaesthesia professionals have always sought to build trust with patients during the preoperative evaluation as part of a focused and targeted evaluation, but this step is even more important when patients experience anxiety from misinformation. Here are several considerations during the preoperative evaluation:

• Seek to carefully inquire about the patient’s misinformation
• Use facts to reassure the patient and their family
• Maintain patient autonomy throughout this process
• Avoid aggressive persuasion for an elective intervention such as a regional anaesthetic. Remember, a contraindication to an elective intervention is patient refusal. In addition, being aggressive will likely fail to persuade the patient, fail to build a trusting relationship, and reinforce negative perceptions of health care professionals.
• Use tools such as empathy, patience, and a willingness to listen to a patient’s concerns to help address any concerns

Recently, regulatory agencies and public health organizations have recognized the dangerous impact on patient safety related to medical misinformation. The United States Surgeon General released an Advisory on Building a Healthy Information Environment in 2021 which offers further recommendations for health care professionals dealing with false or misleading data. I will include this citation in the show notes as well so you can check out the complete advisory statement. Some of the recommendations include the following:

• Proactively engage with patients and the public regarding health information using empathy and accessible language
• Use technology and electronic communications platforms to share accurate health information with the public at large
• Develop partnerships with community and local officials to help create localized messaging to address health care concerns in an accurate manner.

Medical information comprises a whole new language filled and it may be especially difficult to verify accurate medical information for patients and family members who do not have medical training. I’m sure many of our listeners have been asked by friends and family members to help them understand medical information. Another important step is for medical professionals who interact with patients during the preoperative period, which may be nurses, surgeons, or other medical consultants, to refer any discussions about the anaesthetic plan especially the choice of techniques and associated risks and benefits to the anaesthesia professional who will be providing care for the patient. There may be confusion when an unqualified medical professional makes suggestions about possible anaesthetic techniques, medications, and potential side effects. This confusion can cause undue stress and anxiety during this critical time.

This is an important point: “The preoperative evaluation and consultation with the designated anaesthesia professional will be the single most important source of relevant information for a patient and their family.” This is a great responsibility for the anaesthesia professional and an important step for keeping patients safe.

It is likely and understandable that patients may want to consume information about anaesthesia before their procedure. Prior to the preoperative period, patients can be directed to a trusted and reputable source for medical information on the internet. An excellent resource for this is the APSF Patient Guide to Anaesthesia and Surgery. Don’t worry I will include a link in the show notes and we are going to be talking about this guide on the podcast in the upcoming weeks.

There is a call to action for anaesthesia professionals to recognize the very real impact of medical information on patients and their families which may affect patient’s perceptions regarding anaesthetic care. Going forward, we must use empathy, patience, and facts to address medical misinformation to prevent fear and anxiety, delayed treatment, or the avoidance of appropriate medical care in our continued quest to keep patients safe during anaesthesia care.

We made it to the end of the article. Don’t worry there are still so many new articles from the February 2025 APSF Newsletter for us to discuss!!

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.

© 2025, The Anesthesia Patient Safety Foundation