In November 2008 after Obama was elected, I had a patient in clinic who said she was disappointed by the election result.

She cited a jaw dropping falsehood about what she thought his election would mean for healthcare, and especially healthcare for white people. /1

I was frankly shocked when she said the falsehood, as it was nothing I had ever heard anyone say before. She had no history of psychosis or delusional thinking.

We spent a while talking about her statement, and why her healthcare was secure (she had Medicare). /2

I remember thinking, "where did she get this from and how could she believe this?" The belief clearly had racist element.

The issue never came up again.

The truth was the truth. It didn't matter what she believed. 3/

Don't health care professionals have these moments all the time, when patients bring up kinda shocking beliefs/myths/etc about how the world works?

Maybe not every day, but it happens a lot. People are not always well informed. 4/

When people bring up myths about their illness or healthcare itself, we usually deal with it 1-1 with the pt.

We explore underlying concerns and try to address those concerns as best we can, either through communication or action.

We have AGENCY to respond to the issue. 5/

Fauci said he was "stunned" that so many see the pandemic as "fake." I've also heard colleagues express disbelief about how lackadaisical many in the public are.

I share this to an extent, but really, disbelief isn't the main feeling I'm having.

It's helplessness. /6

If you've been practicing medicine for a while, haven't you had enough people individually bring up wild ideas about how the world works to say, "yeah, actually I'm not all that surprised."

The piece that's hard is the group think, and that we have so little control. /7

So for me, the main emotion is helplessness.

I feel helpless in the face of so many who aren't taking this seriously, and I'm sure you do too.

The only way forward for most of us is one patient at a time. /8

Sure, those who have a megaphone should continue to blast accurate and understandable public health messages.

It's really important.

The rest of us can amplify these messages. /9

Just remember that you've been here before with patients' mistaken beliefs.

One on one with patients and their families is where we, as physicians and other healthcare professionals, have our greatest agency. /10

NONE of us dispute that pandemic restrictions have come with hardships for many.

When patients express skepticism about public health guidance, SET ASIDE (for a moment) the inclination to reinforce what you know to be true.

They have heard it all before. /11

Explore how following public health guidance might be impacting their life in other ways (social isolation, loss of income, etc).

This is what the restrictions MEAN for most people. /12

Explore how they are talking about coronavirus and the restrictions with others around them. You'll hear about the groupthink (and also the arguments).

To go against the grain of one's in group FEELS like a threat to their identity (even if not). /13

IF you can figure out how public health guidance impacts a person in potentially negative ways, then you can acknowledge that (and sometimes work to mitigate with help of social workers, etc).

And then they may be more open to hearing you speak the truth about prevention. /14

Don't expect them to change their mind instantly. Most of the impact of physician/pt communication comes AFTER the visit.

As with all other healthcare, the maxim is true with pandemic communication:

"They don't care how much you know until they know how much you care." /fin