'On Message': Lessons From One Doc's Inadvertent Media Tour

Recently, I (Dr Olvera) had the experience of a neurologic research publication I co-authored start to gain attention in the mainstream press. In short order, I was approached by a popular online news source for an interview.

When a member of my practice asked, "Have you had any media training?", I couldn't help but laugh. Why would I ever have done that? I don't want to be a "celebrity doctor." Are nearly 14 years of schooling and training not enough?

Although I thought it was a ridiculous question at the time, what I've learned since then has taught me otherwise. In our increasingly online and interconnected world, having a familiarity with social media and other sources of information is an important aspect of the art of practicing medicine.

Many have noted the causes of burnout afflicting neurology and other fields of medicine: increasing patient volumes, attrition of doctors, the advent of electronic medical records, and mounting financial pressures. This has led to a deterioration in the doctor-patient relationship, as the quality time we spend together continues to decline.

It probably will not surprise any practicing clinician that despite our 30-minute semi-yearly appointments with our patients, we may no longer be their only source of health information. More than 80% of US adults now get their news on the internet. This trend holds true for health information, for which the internet is the most popular source. A 2014 survey found that over 70% of adult patients use the internet for finding health information.

In the intervening years, a number of news sources have grown to meet this need, primarily in the form of social media, which an estimated 70% of US adults currently use. Although the popularity of social media sites varies by age, the majority of US adults in every age group uses them. The crux of the problem with the news reported on these sites remains a serious lack of authenticity.

Medicine, with all its nuances, is under no obligation to be easily understood or expressed with a sound bite. Yet this may be exactly what is sought by the average internet user, who spends only 10-20 seconds per webpage and who is likely to abandon a webpage if it takes longer than 3 seconds to load.

The health information detailed within our verbose and expensive medical textbooks poses no competition to the catchy headlines, fun graphics, and easy-to-understand language of these online health information sources.

In the new age of social media, a user can scroll from one post to the next within a fraction of a second. Aside from attention span, online sources also must compete with each other, as many will cover the same topic. For example, a quick Google search of "Tourette syndrome" yielded over 10 million results in 0.69 seconds. It is impossible for the untrained eye to review differing opinions, often not based in evidence, on a symptom or disease state and make a well-informed decision.

How can physicians compete with millions of flashy and readily accessible online sources to take good care of our patients?

Well, ultimately, most healthcare providers aren't trying. In a survey of practicing physicians, 74% did not have a personal or professional social media account, which compares poorly with everyone else (patients). Only a third felt comfortable in their ability to search social media for medical content, and even fewer understood the use of the now-pervasive "hashtag" for medical education.

Only 10% felt comfortable with their ability to create and curate medical topics for social media. Consistent with my own initial scoffing at the concept of "media training," fewer than a third wished to learn more about social media to enhance their medical skills.

The Evolution of a Media Training Skeptic

I, however, am no longer averse to the idea. This was brought about during my research into the so-called "TikTok tic" phenomenon, whereby the popular video site was thought to contribute to tics more commonly associated with Tourette syndrome.

In initially explaining my social media research in this area to other subspecialized movement disorders neurologists, there was some novelty, as well as some element of controversy, to the topic. This foreshadowed the difficulty I would have explaining the same topic to the now numerous news sources that cater to a global and diverse audience.

The conclusion of my research was that the tic-like movements featured on the most popular TikTok content were consistent with a functional or "psychogenic" neurologic disorder (FND) rather than true Tourette syndrome. This is in line with previous research on similar movement disorders.

Aside from some wonderful reporters who spent hours asking poignant and thought-provoking questions, the conclusion in much of the widely circulated media was that "TikTok tics" — because they were not Tourette syndrome — were fake. This was echoed by the hundreds of comments left on these online news articles and websites, which I regretfully spent one afternoon reading.

I was understandably upset by the public's response. The last thing a physician would ever want their patient to think is that we believe their complaints to be "fake," effectively worsening their suffering.

In retrospect, I was incredibly naive to not think about how what I was saying could ultimately be simplified to a 20-second blurb. Partly, this media response may reflect the stigma of FND, even among neurologists. Such disorders may still often be referred to as "psychogenic" or "inorganic." In a survey of 349 neurologists, only 7% considered FND to be a "disorder of brain function" and the majority believed FND to be related to feigning.

I eventually decided to cut myself some slack. If there's still controversy surrounding a topic, even among the most specialized medical professionals, how are physicians going to effectively explain these complex and nuanced topics to others?

While at first glance it may seem yet another digression from the golden age of medical practice, we must remember that all good relationships and clinical care start with empathy. As physicians, we now have an ethical duty to our patients, and to medicine, to educate ourselves about available online health information. The fact is, most of our patients are going to continue to spend more time seeking out and consuming online health information than they will ever spend in our offices.

We may end up needing that "media training" after all.

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