How to Break Through Medical Skepticism

A dose of skepticism can be healthy. Skepticism may encourage individuals to get a second opinion when they feel they have been misdiagnosed. It may also encourage people seeking out health information to validate the sources in an article claiming to offer credible medical advice. 

But in a digital world where misinformation can spread like wildfire and can be amplified across influential platforms, skepticism can also be a troubling sign. Like many other groups and institutions, medical scientists have seen a dip in levels of public trust, according to the Pew Research Center. And even a small loss of trust in medical science can potentially have negative effects on health outcomes. 

Still, Americans’ level of trust in medical scientists remains high at close to 80% as of December 2021. And practitioners are often trusted more than researchers. In fact, in Gallup’s annual Honesty and Ethics poll, Americans ranked nurses highest among 22 professions, followed by medical doctors. Examining the skills that earn medical professionals trust among the general population could be the key to unlocking how to address medical skepticism in healthcare settings and also when individuals encounter it in their day-to-day lives.

Although there are many different definitions for the term, medical skepticism has been defined as “doubt in the ability of conventional medical care to appreciably alter one’s health status.” 

Medical skepticism has been defined as “doubt in the ability of conventional medical care to appreciably alter one’s health status.”

Melody Butler, BSN, RN, CIC, is the founder of Nurses Who Vaccinate, an organization dedicated to connecting evidence-based public health advocates with the public.

According to Butler, when it comes to medical skepticism, patients often fall into one of five distinct levels:

Pro-Treatment: A patient who is on board with treatment. 

Pro-Treatment But Hesitant: A patient who is on board with treatment but has questions and requires some guidance to feel comfortable.

On the Fence: A patient who has many questions and needs significant guidance in order to make a decision about treatment.

Anti-Treatment With Exceptions: A patient who identifies as unwilling to receive treatment, but makes exceptions. For example, a person may identify as anti-vaccine, but may be open to certain vaccines, such as the meningitis or polio vaccines. 

Adamantly Anti-Treatment: A patient who may belong to anti-treatment movements or organizations, or even be a part of the anti-treatment establishment. They may intentionally promote propaganda.

While the anti-treatment group receives a significant amount of attention, there are many valid reasons that people are skeptical of conventional medicine. For example, various studies have shown that different racial and ethnic groups, like Black Americans, have a mistrust or skepticism of the medical field due to historic mistreatment, as well as current experiences with systemic discrimination and poorer care in healthcare settings. Similarly, LGBTQ people may hold misgivings about seeking care if they feel they will be denied access and proper treatment or will be stigmatized by professionals in the field.

There can be legitimate reasons to feel skepticism and mistrust of the medical field, but they can also have serious adverse consequences. As numerous studies have shown, mistrust can prevent patients from both seeking care and accepting care (PDF, 65.1 KB), which can exacerbate health disparities. Conversely, patients who have high trust in their healthcare professionals have reported greater satisfaction with treatment and higher quality of life.

A complicating factor is the rapid spread of medical misinformation. The World Health Organization and the United Nations have labeled the proliferation of inaccurate medical information related to COVID-19 as an “infodemic,” prompting the Office of the Surgeon General (OSG) to release a framework for how to build a healthier information environment.

In its response, OSG explains how misinformation has been able to spread so quickly on online retail sites, social media and search engines, through three overarching steps:

While some online information may be intentionally deceptive, OSG notes that many people who share it may not be attempting to mislead others. Still, the consequences of sharing misinformation can be significant. In the context of the COVID-19 pandemic, OSG reported that exposure to misinformation resulted in people refusing to participate in public health measures, refusing the vaccine, and taking alternative but unproven treatments. 

Medical Misinformation Terminology

Medical skepticism is often inspired by false medical information, which can come in many forms. 

Misinformation: False information that is spread, regardless of whether there is intent to mislead.

Propaganda: Information, ideas, or rumors deliberately spread widely to help or harm a person, group, movement, institution, nation, etc.

Disinformation: Deliberately misleading or biased information; manipulated narrative or facts; propaganda.

Fake news: False news stories, often of a sensational nature, created to be widely shared or distributed for the purpose of generating revenue, or promoting or discrediting a public figure, political movement, company, etc.

Conspiracy theory: A theory that rejects the standard explanation for an event and instead credits a covert group or organization with carrying out a secret plot.

Pseudoscience: Any of various methods, theories or systems considered as having no scientific basis.

Antiscience: Anything that is opposed to the principles, methods or aims of science.

When addressing medical skepticism in a healthcare setting, efficient communication techniques can improve the patient relationship, making patients more willing to consider new ideas and even change their minds. Butler recommends using a communication framework to keep appointments focused. There are many different communication frameworks to choose from, so Butler encourages practitioners to choose the one that proves to be most successful with their clients. 

BATHE Framework:

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Background: Ask about the patient’s concerns.

Affect: Ask the patient how they feel about their concerns.

Trouble: Ask the patient what’s most upsetting about their concerns.

Handling: Ask the patient how they’ve been managing the situation.

Empathy: Empathize with the feelings the patient has shared.

CASE Framework:

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Corroboration: Emotionally validate the emotions motivating the patient to share their concerns. 

About Me: Share how you know what you know, which can range from your credentials to your experiences with the topic. 

Science: Share the science on the topic.

Explain: Add up all the above, and you end up with an explanation of why you’re providing the advice you’re providing.

Butler shared how the CASE model could influence the flow of a particular conversation, in this instance about coronavirus vaccine hesitancy.

Corroboration: ​

• The practitioner corroborates the patient’s sense of alarm. They acknowledge their fears and reasoning for hesitancy, letting them know that their feelings are valid.
• “I totally agree that this can be very scary if you’re reading this for the first time.”

About Me: 

• The practitioner establishes their credentials and explains what actions they have taken to make themselves a credible source of information. 
• “As a nurse I’ve gone to conferences about this particular topic. I work with and I speak to the experts. I have a rapport with medical researchers who have worked on this particular area and this particular vaccine.”

Science: 

• The practitioner explains the science on the issue and debunks any myths, keeping health literacy in mind and avoiding highly technical terminology.
• “Studies have shown that people in your age group are at the highest risk for adverse effects from an infection. This vaccine has gone through extensive trials and has proven effective for older patients.”

Explain: 

• The practitioner provides recommendations for treatment with an explanation behind that advice. 
• “As a nurse and as a mom, I recommend this vaccine. I gave it to my own kids, and I took it myself.”

An article on addressing vaccine hesitancy published in Minnesota Medicine offers more specific examples of how to use the CASE framework in this context. 

If patients choose not to move forward with the advice given by the practitioner, it’s important to note that and to consider any alternative treatments they may use instead, in order to avoid interactions with medication and to monitor changes to the patient’s condition, Butler says. 

Individuals with friends or family who express medical skepticism can lean on many of the same tools and strategies a medical professional would use.

Butler offers the following advice to individuals: 

Talk in private: A more intimate conversation communicates the importance of the talk. In public, someone might feel less willing to admit they’ve been wrong, and may end up speaking to the crowd more than to the individual. 

Normalize care: When people are medically skeptical, it can be helpful to learn that those around them get conventional medical care. So, for example, the individual can share that they have been vaccinated.

Dismantle stigma: Stigma, such as anti-neurodivergent bias, fatphobia, ableism, ageism, etc., makes people more vulnerable to misinformation.

Establish trust: An individual should enter the conversation well-informed and having done research, but should also emphasize that the talk is taking place because they care about the person.

Find the why: It could be a particular fear, a bad doctor’s visit, a story from a friend, etc. Whatever it is, having the person express why they’re skeptical can be key to helping them seek medical treatment. 

Acknowledge your feelings: If someone who’s medically skeptical says something surprising that elicits a reaction in you, acknowledge your response as a legitimate expression of concern.  

Get back to them later: If an individual becomes overwhelmed, drained, or needs to do more research, they should resume the conversation later. 

Be patient: It may take more than one conversation to get someone to change their mind if they change their mind at all. Leave the door open for future communication.

Set and respect boundaries: Boundaries are a two-way street. Engage in the conversation if both parties are open to talking about it. 

Ask for help: Another individual or expert may be better suited for the conversation. It’s OK to ask them for help. 

Take breaks: It’s OK to take a break from trying to change someone’s mind, to stop trying altogether, or to not talk to that person at all if it’s too upsetting or harmful.

To deal with medical skepticism, medical practitioners and other individuals may also want to proactively address the sources of misinformation. Butler advises deleting misinformation that’s left as comments on official social media. There’s no responsibility to leave comments up, and simply seeing misinformation repeated can make someone more likely to believe it. 

Medical professionals can also lean on their expertise and credentials. When they see somebody repeating false or misleading information, Butler recommends professionals leave a positive, non-combative correction with a suggestion for a doctor’s visit. 

Prebunking is another strategy that could help stop the spread of misinformation and pseudoscience. Prebunking posits that it can be more effective to teach people to identify misinformation so they’re less likely to believe or spread it in the first place.

The Association for Psychological Science offers the following tips for identifying pseudoscience:

• Pseudoscience tends to provide after-the-fact justifications for why claims can’t be proven false. 
• Pseudoscience is overly concerned with proving things right rather than proving things wrong. 
• Pseudoscience tends to put the burden of proof on people who doubt pseudoscientific claims rather than those who are accused of making them.
• Pseudoscience uses anecdotes and testimonials as evidence rather than using data or tests. 
• Pseudoscience avoids peer review.
• Pseudoscience often uses scientific language to create the appearance of being rooted in legitimate science.

Skepticism can be a powerful tool that informs how people act and feel. Skepticism can even mean the difference between life and death. It’s no wonder, then, that applying skepticism to medical skepticism can have equally transformative effects. With these tools, individuals can help skeptics doubt their own doubt, and in doing so, help set them free from the grip of misinformation. 

Please note that this article is for informational purposes only. Individuals should consult their healthcare provider for any health-related concerns.