Lack of Medical Knowledge in the General Public: The Challenges, Threats, and What Can Be Done

Lack of Medical Knowledge in the General Public: The Challenges, Threats, and What Can Be Done

As current fourth-year medical students about to become interns, we will begin by sharing our experiences with patients and the various misconceptions of medicine that we have encountered.

 Melissa: Several months ago, I worked in an inpatient hospital ward, at a county hospital, with a heavily Spanish-speaking community. Many of the people in town were migrant farm-workers. I learned a lot of lessons from this experience. Aside from language barriers, even with certified medical interpreters, the population was difficult to work with because they often did not have any health education or regular access to medical care. The treatments this population used for common ailments were often blatantly dangerous.Two examples stick out in my mind. The first was a middle-aged male with diabetic foot ulcers. Despite several prior hospitalizations for infections of his ulcers, he tried to treat the ulcers by putting raw meat on them. That patient was also a Type I diabetic, so the diagnosis was not new to him; however, he never had any education about how to properly control his diabetes and treat ulcers. The other example that comes to mind is another middle-aged male with diabetes. He came to the hospital with severely elevated blood glucose. He knew that he had diabetes, and he tried really hard to take care of it properly. However, he was drinking extra Coke when his blood sugar was high because he thought that was what he was supposed to do. Ashley: When I first heard you tell me about the person who rubbed raw meat on his diabetic ulcers, I was in complete awe and disbelief! I have no idea where people come up with these misconceptions of treatment or how they become a tradition passed down generations. During my time in the clinic, I have not come across as extreme a case as this, but there have been many times throughout my experiences where I have met people who have not been to the doctor in years. This does not sound dangerous on its face, but this also includes missing out on crucial annual preventative measures, such as cervical cancer and breast cancer screening. During my time as a scribe for OBGYN, I witnessed someone who had mild cervical dysplasia, had a procedure done to remove the abnormal cell growth, and then was supposed to follow up yearly. She ended up not coming back for years and continued to smoke tobacco (which can exacerbate abnormal cell growth), and ended up having progressed cervical cancer, where not much could be done at that point. Another experience as a medical student in my OBGYN rotation, includes a woman coming in for a cervical pap smear, with her last being a decade ago. She explained that in her Hispanic culture, it was not appropriate to discuss women's health or illness in general, and she did not understand the importance of regular screening for cervical cancer. One last recent example is, during my cardiology rotation, a person came in with severe heart failure and pulmonary hypertension. It turns out he had such discomfort and dislike for doctors, that he diagnosed himself online and was purchasing medications from a foreign country. When he finally came to the hospital, his prognosis was so poor, there was not much that could be done….I wish I could say these instances are extremely rare, but unfortunately, I think they are more common than we would like them to be. Trying to divine why people wait so long to come in for help or practice seemingly odd treatment regimens, is a challenge. I believe them to be multifactorial, whether it be deeply ingrained cultural practices, lack of basic medical knowledge, lack of awareness of the implications waiting can have on your life, fear of mortality, distrust of healthcare, lack of resources, financial constraint...this list can go on.  Melissa: Every time someone comes in and reports that they never go to the doctor, or haven’t been in years, I can feel myself tensing up while I wait to hear about what brought them in. And I do this because, similar to what you have experienced, these tend to be the sickest patients and/or the patients with the fewest options left. And it’s heartbreaking because it may not have had to get to that point. It feels like COVID19 has become the newest poster child for health misinformation. I recently finished a rotation in an emergency department. Some of the things that happened over the course of my month there were really surprising to me. Despite being nearly a year into this pandemic, people still don’t understand the importance of masks and isolation. I lost count of the number of rooms I walked into where the patient was not wearing their mask. When asked to wear the mask, most did. Some did not, though -  citing that they were unable to breathe with the mask on. And while in the emergency department, some patients genuinely cannot breathe, it was usually not those patients that were refusing to wear their masks during interactions with healthcare workers. These patients understood that their ability to breathe was not limited by a layer of cotton, but instead by their physiology. It was the patients who were walking, talking, and breathing who were often resistant.It was also interesting to see how people came into the emergency department. At the time, the emergency department allowed patients to have one visitor with them. Unfortunately, many folks don’t have the luxury of getting themselves to the hospital without help from someone else. However, some of the able-bodied people who were coming in to be seen for COVID symptoms would bring in other, asymptomatic family members who had the same COVID19-positive exposures as them, which unnecessarily increases the risk of viral transmission, as we now know how prevalent asymptomatic transmission is. Ashley: Yes, yes, and yes. COVID 19 and the battle of the masks! This virus has unfortunately become so politicized and misunderstood that science and logic appear to not be taken seriously. Again, the reasons for this may also be multifactorial, but the dangers of people not following healthcare guidelines for various reasons poses the risk of continually propagating the virus without any hope of eliminating it. I recently had a beloved one inform me that they would rather catch the virus naturally than through a vaccine, not understanding that the vaccination is to help generate an immune response to the virus, and that this is a protective measure from ever “catching it”. They failed to understand that you would not catch the virus by being vaccinated, hence, their refusal to receive it. The implications of this pose catastrophic for some, and in this instance, it appears to be due to a misunderstanding of basic immunology and how vaccination works. I was initially shocked, but upon reflection, maybe this lack of medical knowledge is not someone’s fault, and maybe this could be addressed somehow.  Now, we will address the problem with the lack of medical knowledge in the general public, and the potential consequences: COVID19 has brought to the forefront how dangerous lack of health literacy can be. Frequent stories are in the news about protesters refusing to wear masks because they believe, despite data contrary, that the virus is no more dangerous than the annual flu. While initial information about the virus was confusing, there is a lot more that is known about the virus now. Data has demonstrated that most people infected with COVID-19 will have a mild-moderate illness, and as many as 30-40% of infections are asymptomatic (1,2). Interestingly, one small study showed that of the people who had asymptomatic COVID19 infections, 70% had typical or atypical findings on a lung CT (3). So even though people may never even experience symptoms from the virus, we don’t yet know what the long-term consequences of infection will be, especially if we can already see changes on imaging. Finally, we do know that COVID IS more dangerous than the annual flu. COVID19 patients who are hospitalized are five times more likely to die than hospitalized influenza patients (4).Now, we will address what can be done to educate the general public to prevent potential catastrophic outcomes.  Melissa: It’s difficult to come up with a solution to misinformation and poor health literacy. Aside from a little bit of nutrition education and physical exercise, I remember having very little education on health when I was growing up. Ashley:Melissa, same! It’s also about the environment you grow up in. If you grow up in a healthy household, you are more likely to grow up having those same habits in adulthood. If I had not attended medical school or scribed for an OBGYN clinic, I would also feel in the dark about the importance of preventative screening or have been able to recognize red flag symptoms I or someone else was experiencing. I feel many people rely on the internet, which although may seem helpful, can pose issues if they attempt to self treat, as seen in the cardiology example provided earlier.  Melissa: I agree with you about the internet. I think that is a great resource for people to learn about health, but people need to know where they can get reliable information.  I am certainly no public health expert, but ideally, there could be some degree of basic health education provided in schools. The challenge is that the topic of human health is very broad, and while there is some partnership between governmental and local organizations to implement these things, there is undoubtedly an unequal distribution of these resources. As with many other issues, poorer school districts do not have the local resources to implement additional programs the way wealthier districts do.  Ashley: Melissa, that is an excellent idea. I also think educating both parents and children is crucial and I would love to see some type of program like this implemented in the school system. I also think mental health education for both parent and child is also equally important. During my experience as a crisis text line counselor, I have lost count on the amount of times children felt completely helpless and in need of a counselor, but were too afraid to ask their parents for permission to see one, because they felt their parents would “judge them” or not understand and tell them to snap out of it. This leads to increased calls towards crisis hotlines, and could even lead to increased suicidality. Reflecting on the multifactorial reasons people don’t seek healthcare, I also believe in the importance of understanding different cultures and their practices. As the complexity of this matter is not something that can be addressed easily, possibly if we start by seeking insight into the negative assumptions associated with modern medicine, we can begin to bridge this gap. Lastly, financial constraints and lack of access to healthcare has been a long standing problem and is an absolute contributor to poor health literacy as well as the inability, and likely resistance, to seek healthcare or healthcare knowledge. In the age of COVID-19, telehealth has become successfully mainstream and looks like it will continue to be here long after the pandemic has gone. This has been great for people in rural communities who are not easily able to travel long distances. In my pediatric neurology rotation, people are driving 4-5 hours just to visit their neurologist for 30 minutes. What I find admirable is that my clinic does community outreach 3-4 times per month, where they will fly to various rural communities to provide care. What shocked me is that these outreach clinics are usually booked out 9 months!In regards to increasing health literacy and public knowledge of the importance of healthcare, I feel we could utilize telehealth as a means to engage with our community and perform education seminars. One obstacle I see with this approach is reaching people who remain uninterested in healthcare education. As a future doctor,  humanitarian, and someone passionate about preventative and underserved medicine, I will continue to think of ways to be innovative and never stop reaching out to people in need.    Co-authors: Ashley Maestas, OMS IV & Melissa Mahoney, OMS IV