What’s Worse than Fake News? Fake Health Advice

Why are hundreds of thousands (millions?) of people looking to social media influences with questionable credentials for health advice? This trend of “fitness porn” on social media is becoming increasingly popular. Audiences get hooked by the images of oiled up abs and biceps, they are taught that the photoshopped model with the skinniest waist is the idyllic picture of health. These distorted perceptions show the necessity of the primary care physician. The primary care physician should be the one having these conversations with patients, educating them safely and accurately to improve their overall health, which may include specific diet and exercise advice. Even if the social media influencer does spend the time researching the national diet and exercise guidelines (which these lay people did not), health advice isn’t one-size-fits-all.

Tailoring the details of health, diet and exercise goals to each patient’s lifestyle, mental health and medical history is one of the more rewarding experiences I’ve had as a medical student. I am lucky I have ample time to spend with patients. At this stage I am encouraged to be as complete as possible in my encounters, and this includes discussing the patient’s lifestyle and overall health. I enjoy learning about the whole patient rather than just the presenting complaint. As much as I enjoy independently counseling patients, there have been times that I have wished my attending was present or available to provide additional insight or support when I wasn’t sure what to say. Why don’t physicians spend more time counselling patients? Probably for the same reason that one of my attendings became increasingly annoyed with each question a patient asked during our rounds. He was burnt out, suffering from moral injury, jaded from years of working in a broken healthcare system, and he was paid a salary. If the doctor on call admitted anyone who wasn’t on the verge of going to the ICU, we’d be lectured for hours about how that patient didn’t need to be admitted in the first place. Open with the fact that he had no incentive to take on more patients, or spend extra time with the patients he already had, his clear priority was to discharge everyone ASAP. And the patients realize this, the complaints keeps coming – physicians rush, don’t spend enough time, are typing the entire visit, aren’t making enough eye contact…

But, despite the toll of this “indentured servitude” that attending still cared. Maybe he was bias in favor of the acutely ill patient, but he never practiced bad medicine. He was there when they needed it, when the hard conversations came up, he gave his support. Physicians want to care, but after decades of not being cared about, I can see how it becomes hard. I think it would improve both patient and physician satisfaction if physicians had a way to be compensated for their time. Time might be the most valuable asset a physician has, and decades of it have already been invested into their practice. Who values a physician’s time? In my (albeit limited) clinical experience I have seen little acknowledgement from anyone. The only objective evidence I can recall are the lunches brought in by pharm reps. If insurance companies and employers were to create incentives for physicians, (such as reimbursing physicians for extra time spent with patients, or require them to see fewer patients) patient satisfaction and quality of care could improve significantly. Making opportunities for physicians to counsel patients and build rapport could lead to better educated and healthier patients with improved outcomes. And the patient-physician relationship would strengthen significantly. Allow physicians to take care of all of the patients questions and concerns in one visit (rather than four separate 15-minute visits). Stop making patients feel like an inconvenience, and stop inflicting this moral injury on physicians. The 80,000+ followers that each of these uneducated influences mislead are evidence of the necessity of health/diet/exercise counseling from reliable, educated sources who understand the whole patient and any comorbidities that could alter lifestyle recommendations. Since people aren’t going to stop getting bad diet and fitness advice from social media, the least we could do is promote ways for patients to obtain evidence based advice on a routine basis.

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Kailee Marin

Aloha! My name is Kailee Marin, I'm a DO student in California. I was 15 years old when I decided to go to medical school. I spent three years in Hawaii getting my bachelors, then I came straight to CA to pursue my dream. These three years have been a rollercoaster - the best and worst of my life. I've spent med school listening to, and participating in the complaining of my classmates. I've come to realized that it's all the same. It comes down to the common barriers that current and future doctors face - and it starts in medical school. Moral injury being disguised as burnout so that institutions can pretend they care... But moral injury can't be fixed by wellness Wednesdays, or fitness Fridays. I have realized, to heal moral injury, you have to treat the underlying cause. And there are so. many. causes. So I guess I have a lot to talk about! As an aspiring psychiatrist, I feel compelled to advocate for mental health. This includes the mental health of my colleagues, my future patients, and myself. 

  5 comments for “What’s Worse than Fake News? Fake Health Advice

  1. Seneca
    May 8, 2019 at 2:12 pm

    Warning: Old doctor comment ahead!!

    I long since tired of being a schoolmarm or social justice warrior in my office. If someone is sick, I’ll do my best to fix them. I’ll even do some prevention and screening with the understanding that there is not a lot out there of absolutely proven benefit. Surprisingly, I have no shortage of patients. If you can heal someone, or their grandmother–you have a patient for life. Some people will flit from fitness porn to the syndrome du jour which explains why they are not rich and famous. I have no interest in them and they have little interest in me, until they are ill.

  2. David Dierks Fitzpatrick
    May 8, 2019 at 8:18 am

    Talk to an attorney sometime and he will tell you the ole’ Abe Lincoln quote about time is the only thing that a lawyer has to sell as the reason that they won’t answer your questions ‘off the clock’.
    Isn’t it odd also that the lawyers set up a system where the more experienced they are, the more they bill for services AND they set up a system where we are paid flat, miserable fees.
    Why did we allow them to do this?

    • PW
      May 8, 2019 at 8:58 am

      Because they make the rules.

      • RSW
        May 8, 2019 at 11:26 am

        Because we let them make the rules.

  3. Jennifer Hollywood
    May 8, 2019 at 7:39 am

    Maybe you hit upon one of the reasons that patients like social media advice. It is FREE. Patients also do not value our time. They are unwilling to pay for nutrition or exercise counseling. It’s hard enough to get them to come in at all. They don’t even want to pay for blood pressure management or diabetes care.

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