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The basic premise of being a physician is to use your knowledge and expertise to help patients be healthier and enjoy life by preventing, diagnosing and treating disease. In order to do that, our patients need to trust what we say and do, and join with us in implementing our suggestions. It’s a voluntary contract, one which requires both sides to execute their part of the deal. All too often though, patients don’t go along with the plan. “Noncompliance” is the buzzword of the decade, and even more so in the time of COVID. It’s been an issue forever, of course, but it’s become a bigger issue as trust has broken down between Americans and the health-care system.

But let’s take a few steps back. Noncompliance occurs because patients can’t physically do, understand, afford, and/or don’t agree with what we want them to do. And in this last item, we have patients who think we’re wrong, and those who simply think they know better. There’s a difference, however, between thinking your doctor isn’t correct and thinking that you know better than your doctor.

All this isn’t to say that physicians are always right. We’re not. But it’s rare that a patient is more correct. This didn’t used to be much of an issue.  We can thank the internet of course, and the generally more suspicious mood of the country toward anything that seems institutional. I’m afraid medical school seems to be included in that. We can do better to educate our patients, to talk with them in a manner that includes them and relates on a level they are comfortable with. But how do we respond to those who openly contradict our advice, who accuse us of not dealing with them in good faith with regard to medical issues? This problem goes beyond the standard teachings on how to deal with noncompliance. We’d just started to get our arms around patients who consult Dr. Google and find either incorrect information or information not in the proper context for their issue. This led to productive conversations. But patients coming in with their own idea, however obtained, on how to deal with their health issue, isn’t so easily dealt with.

Everything is real if it’s on the internet, and everything is fake—it just depends on what outcome you want or how you feel about the source. Research confirms that patients seek out validation for their preconceived or desired facts. The scary part is that we as a society have many fewer shared facts. And therein lies the root of the problem and the serious danger that lies ahead. In a very prescient and sobering book, “The Death of Expertise and Why it Matters,” Tom Nichols uncovers the insidious process that’s been creeping into society and undercutting our shared respect and acknowledgement that there are actually people who do know best, and that there are incontrovertible facts. And, while there will always be ‘experts’ who are motivated by other than altruistic motives, at the end of the day there exist absolute truths. We just have to acknowledge them. A T-shirt I saw recently sums up this idea nicely: “Science doesn’t care what you believe.” And like the laws of physics, without some basis of absolute truths, our world will fall apart. 

At the risk of being depressing, I don’t have an answer, only a caution: If we don’t stand up for what is verifiably correct and denounce falsehoods, we deserve the increasingly frequent opprobrium we get. τ