Residents in a Room

Episode Number: 82

Episode Title: Medical Misinformation

Recorded: October 2025

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This is Residents in a Room, an official podcast of the American Society of Anesthesiologists where we go behind the scenes to explore the world from the point of view of anesthesia residents.

It really is a patient safety issue when patients are hearing things that are not accurate medical information.

Potentially we could use AI in science communication focusing on how we could simplify complex scientific topics.

To kind of connect the dots between what they’ve learned externally and kind of bring it into their procedure for that day.

Some of that I also look into just so that I can better understand where patients are coming from.

DR. BRANDON CUNNINGHAM:

Hello, everyone. Welcome to Residents in a Room, the podcast for residents by residents. I'm your host today for this episode, Dr. Brandon Cunningham. I'm a CA2 at Grand Strand Medical Center in Myrtle Beach, South Carolina, and I'm excited to learn from our guest today, Dr. George Tewfik, who is here to talk to us about medical misinformation. And I'm not alone here in tackling this important topic. Let's start out with quick introductions from my fellow residents.

DR. JUSTINE HUANG:

Hi, I'm Justine Huang, I'm a CA3 at the Medical College of Wisconsin.

DR. MEG ROLFZEN:

And my name is Meg Rolfzon. I'm a clinical assistant professor at the University of Michigan and also a postdoctoral research fellow.

DR. CUNNINGHAM:

All right, Dr. Tewfik, would you mind telling us a little bit more about yourself?

DR. GEORGE TEWFIK:

Yeah. Of course. Um, so my name is George Tewfik. I'm an associate professor of anesthesiology at Rutgers New Jersey Medical School, where I also serve as the director of quality assurance, the director of clinical informatics, and the director of the Anesthesia Simulation program. Ao I'm also on the ASA Monitor editorial board and the CME associate editor for Anesthesiology.

DR. CUNNINGHAM:

Great. Thank you. So we'll get right to it. So medical misinformation seems to be pretty rampant right now. Is it as widespread as it sometimes seems or are we just seeing it differently?

DR. TEWFIK:

So that's a really interesting question. I think the answer is both. So the best analogy I've ever heard about medical misinformation is that back in the day before the internet, there was always the town conspiratorial person, the person running around thinking that the moon landing was faked and that they were putting something in our drinking water. So every town had that one guy. But now, with the internet, every town's one guy has connected to every other town's one guy. And instead of having one guy that's shouting and saying things that seem outlandish now, you've got millions of people across the world screaming and yelling the same thing, and it's built a really powerful community. So I think that conspiratorial nature was always there, but this stuff has propagated really easily because that one guy in that remote town has the internet and connects to that one guy with the internet in another town. And now all of a sudden, all of that information has gotten propagated and looks like it has real momentum behind it. So I think that the answer really is both. I think that it is as widespread as we think, and it does seem pretty rampant right now.

DR. CUNNINGHAM:

And social media certainly places those things to the forefront--anything outlandish, attention grabbing?

DR. TEWFIK:

Yeah, absolutely. Social media is really unique in that it gives everyone their own platform and their own voice, which is amazing. It's empowering. This technology really is world changing. Um, you know, it's brought down governments. It's propagated, uh, incredible life changing power for people, um, you know, in terms of movements across the world. But then we're also seeing the potential negative side effects of it, um, in these kinds of things like medical misinformation, where the things get propagated so quickly, um, and really run like wildfire around the world, whereas before they really would have depended on word of mouth and would not have been as widespread.

DR. ROLFZEN:

So how does misinformation impact patients? Is it a patient safety issue and what does this look like in your practice specifically.

DR. TEWFIK:

So medical misinformation can really be a significant patient safety issue. If you think about a patient who's coming in, for example, for a large abdominal surgery and as part of your anesthetic plan, you want to give the patient a thoracic epidural for postoperative analgesia. If that patient has seen something that says that an epidural is dangerous, or an epidural is just a procedure that anesthesiologists do to make profit, then that patient might go against what you prescribe as your best analgesic plan as part of your anesthetic afterwards, and could develop very serious side effects ranging from respiratory depression from opioid use to even increasing their length of stay. Now you amplify that across all different kinds of anesthetic care, such as labor epidurals for analgesia on the maternity ward, or peripheral nerve blocks for large orthopedic surgeries. And you add that up and you've got a ton of potential medical complications out there that really do significantly affect patient safety. So it really is a patient safety issue when patients are hearing things that are not accurate medical information, it really can compromise their care in the hospital.

DR. CUNNINGHAM:

What about the healthcare team as providers? How are we harmed by misinformation?

DR. TEWFIK:

It's a really important question to see how it is that we are harmed personally by misinformation as well. So if you think about our interactions with patients as anesthesiologists, we really are limited by our time. So you arrive in the morning, you set up your room, you go to see the patient, you interview them, and now you're trying to get consent for the anesthetic care. And as you're talking to the patient, you really have a limited amount of time. You got to run back and get your room ready and get everything prepared. So you've really only got a few minutes to establish a rapport with the patient, get the information that you need, and get them to agree to the plan. So we are very time constrained. And what we're trying to do is to build that trust. So if we've got a patient who's, um, antagonistic towards us or views us in a negative light, that really does affect how we are able to establish that rapport, and that ends up getting us frustrated when we're talking to a patient, because we're seeing that they're hearing all this information that's not accurate, that's not the best medical information out there, and we could easily become frustrated or have a negative connotation to that patient or say, hey, that patient's really, really difficult and it affects how we view that patient or their family or their care. So it's really easy to get frustrated and and to get very upset with how the day is going, uh, by having these kinds of interactions with patients that are tainted by potential medical misinformation.

DR. HUANG:

So inevitably, when we are in those situations, what can we do as anesthesiologists to kind of minimize the impact of misinformation? Do you have any advice on how we can best address these patients concerns?

DR. TEWFIK:

Absolutely. I think the most important thing is to be empathetic. It really is very frustrating to walk into a patient's room and either they're saying medical misinformation or you hear their family or friends saying things that are you just know are flat out wrong, or from some TikTok video or from, you know, some Instagram reel that, you know, that they just watched that said something kooky. It's very easy to get frustrated. But if we start from a place of empathy and recognize that this patient, you know, is coming in to deliver a baby and is maybe really scared and is really susceptible to hearing things, and to to say to ourselves that that epidural might be the scariest thing that this person has ever come across in their medical care. Um, once you start from a place of empathy, you can take a breath and you can say, hey, I know you've heard this, this theory about epidurals. Let me explain to you what it is that you've heard and why it is that I think that our medical community would disagree, and I think that this is the best option for you. You allow them to retain their sense of autonomy, which is super important in these kinds of interactions as well. And you try not to push undue pressure on them or try to sway them, um, you know, in an excessive manner. Uh, but if you start from a place again of empathy and recognize that we do, you know, ten, fifteen, twenty epidurals a day and we do tons of spinals a day, and we might be, knocking out a dozen nerve blocks. This might be the only time in their life that they've got someone putting a needle in their back. And to them, it's the biggest deal of all. Um, so if you understand it from that perspective and take a moment to take a deep breath and to approach that interaction with patients, I think that that really does help to dispel these myths and hopefully gain that patient's trust.

DR. ROLFZEN:

So when we think about large language models and generative AI, we talk about things in the context of misinformation being propagated from the training models that they were trained on and different misinformation that is being propagated in other social media contexts. Do we need to be worried about misinformation coming from large language models or generative AI models?

DR. TEWFIK:

Yeah, I think that large language models and AI have the potential to be hugely impactful through all aspects of our life. But it's something that really does concern me because, like you said, they are trained on large amounts of data. But the thing about it is that it worries me because we're not really sure what that data is. So, interestingly enough, recently I was concerned about this myself and played a little experiment, and I asked, ChatGPT is an epidural safe? And it gave me a great answer, a straightforward scientific answer that I would agree with, and that I would recite pretty much verbatim to a patient myself. Epidurals are safe. They're the preferred method of choice for labor analgesia for a whole host of reasons. But then I tried to dial in a little bit more. What are your sources? And it said, you know, it's a combination of scientific papers and regulatory agencies and statements from professional organizations. All good so far, right? But then I asked it, what are the specific sources? Give me the actual websites. Give me the actual papers. And it wouldn't do that. So that raises a bit of a red flag for me, because we've all seen papers published and we've seen statements from regulatory agencies that we don't necessarily agree with, that the ASA does not necessarily agree with. And what is it weighing each of those different sources as? So I think for us to be able to trust in them and say to a patient, hey, you can look this up on ChatGPT and it's going to give you a good, reliable answer, we really need to be able to dial down as far as possible to find out the original sources of these things. When you go to submit a paper to a scholarly journal, they don't just trust you that you cited thirty papers. They want the thirty citations. They want the actual papers that you've cited and are going to as reliable sources. You can't just say, trust me, I cited thirty people about this information. So I think for these large language models to really provide us with that additional layer of information and assistance in speaking to patients, we really do need to be able to dial down. I don't know if that's something that's going to change moving forward. I really hope it does because this technology is amazing and we're using it so fast. If you look at ChatGPT history, it was the fastest app to ever gain a million users, and then I think one hundred million users as well, right out of the gate. So this stuff is out there. It's all over the place. People are using it in all kinds of interesting, creative ways. It really does have the potential to be transformative technology, but we've got to scrutinize it in a way that we would scrutinize any other medical information that gets out there.

DR. ROLFZEN:

Right. To trust a platform, it has to show a certain level of transparency, and clear sourcing is a part of that. I've run into the same issues when asking for a detailed bibliography of an output, and the output looks to be something that would be a reliable source, and you dig in to the specific journal in the year it was published, and the author list is completely different than the one that it provided. So in that way it's sneaky. Mhm.

DR. TEWFIK:

Yeah. It has a tendency to hallucinate. Um, which is something that I'd read about but had not actually experienced. And it gives an answer that looks really scientific and really professional and cited. And then you go to dig in, like you said to the sources and the author list is wrong. The title is wrong. The exact citation that it gives you in a journal is wrong. Um, so it really throws doubt potentially on everything. So whereas I like the top line answer for is an epidural safe, I want to make sure that the actual information that that final answer is built upon is reliable, and that we understand the sources and that not just that we understand the sources, that it's giving proper weight to each of those sources.

DR. CUNNINGHAM:

Are there any specific myths at the intersection of anesthesiology and misinformation that you'd most like to dispel?

DR. TEWFIK:

There's a lot of them. Um, you know, we get patients all the time, in our hospital that come in and have heard all kinds of things dating back to when Michael Jackson died on propofol. Uh, I was a resident at the time, and we had patients coming in and they would say stuff like, you're not giving me that white stuff that killed Michael Jackson, are you? So patients hear this kind of stuff all the time, and it really can impact their patient care. So, it's kind of a game of whack a mole in terms of medical myths that we want to dispel. last week we had a patient saying that they don't want Tylenol now. We just kind of have to knock these things down again, starting with empathy, um, and be able to confront them and say, hey, I totally get that you're super scared right now. You're pregnant and you don't want anything that's going to, you know, compromise your baby or, you know, you don't want to suffer the fate of Michael Jackson, which is totally understandable. Or Matthew Perry with ketamine. You know, these patients hear these kinds of things all the time, and we've just got to take a deep breath and say, I totally get it. You're scared. This is potentially scary stuff. Let me explain to you why this medication is safe. And a lot of times there are alternatives. If a patient is really that scared, the safer thing to do in terms of patient safety might be to change your anesthetic plan. Um, you know, because having a patient with huge amounts of anxiety can cause physiologic changes that can affect them afterwards. So we've got to be mindful of that as well.

DR. ROLFZEN:

I think this is an interesting topic that plays into the communication of science to our patients. I think the flip side of misinformation is being able to communicate in a way that they understand. And the way that I would argue about, for example, Tylenol is by showing them all of the research that shows that it's safe. But many patients would not be responsive to research or data, and it would be more prudent, or more effective to be empathetic and start on a relational level. This kind of explores, you know, potentially we could use AI in science communication, focusing on how we can simplify complex scientific topics and improve public understanding. Um, and I think that that is a really interesting, uh, research area or field for the future.

DR. TEWFIK:

Yeah. If you think about it, our patient physician relationship, you know, it's one of those common tropes. Why do physicians get sued? And the number one reason generally is because they don't like the doctor. It's not necessarily tied to outcomes or, uh, choices that the physicians make. A lot of times it comes down to they that they just don't like you. So we could approach it with data and we could approach it with science and that I completely advocate that. But building that trust with that patient really is probably the thing that will go the longest way. Why do people follow certain social media influencers? They like them and they trust them. So become a trusted source and they believe everything that they say. We are unfortunately limited by the fact that we meet patients about ten minutes before going into the operating room. It's really hard to establish good trust in that time period. But once you've started your training and once you get out in your practice, you learn how to establish that trust with patients. You learn to not be curt with them and to come from a place of empathy and really to speak to them and their family, potentially, and to build that trust. Once you've built that trust, you could say words like randomized controlled trial, but it won't go as far as saying, you know, this is what I believe and this is what I would do for my family. That's really, really impactful, that really if I was sitting in your shoes and I was getting, um, you know, a total knee replacement, this is what I would choose for my analgesic plan. And this is what I would do for my mom if she was here as well.

All right. So now let's flip the script. Can I ask you guys a few questions. So what are you all seeing on the ground? Do you see fallout for medical misinformation in your hospitals?

DR. CUNNINGHAM:

I would say that generally over the past few years, my patients are more informed on general medical knowledge, on their procedure, about what even goes into an anesthetic plan. But it's the waters are fuzzy as well, too. They don't have the larger understanding of what goes on in medicine throughout everything. And so it's that's where we can step in as the anesthesiologist to kind of connect the dots between what they've learned externally and bring it into what's going to be going to their procedure for that day. And so again, it goes back to it's both good and bad.

DR. HUANG:

I would say something that um, more recently when fentanyl was made into like a schedule one drug, I had even not just patients, but friends and family coming to me and saying, oh, you can't use fentanyl anymore. And I had to look into it and be like, well, this is not the controlled fentanyl that we use in the hospitals. And then we had patients coming in also saying like, oh, I don't want any of the fentanyl. And that's obviously a drug that we use very, very frequently in the operating rooms and for analgesia plans post-op. So seeing like medications that we use very frequently kind of appear on like as you were saying, about like propofol and ketamine. And having to dispel those can sometimes be a little bit of a frustration, but also something that gives us an opportunity to explain a little bit better.

DR. ROLFZEN:

Yeah, I think I've seen misinformation not only in the hospital with medication management as as we just alluded to, or the perception of staff roles in the perioperative environment and how those have been shifting, or when social media has shaped a narrative regarding the expectations surrounding anesthesia, surgery, recovery, but also in the scholarly realm. David Markowitz, he's a PhD in psychology, has a published paper in 2024 in PNAS Nexus, looking at how the percentage of Americans that see research scientists as intelligent and able to communicate. Eighty nine percent of of the people that he interviewed saw them as saw a research scientist as intelligent, but only forty five percent said that they're good communicators. And they thought that anything that was more simplistic was AI generated, whereas anything that was more complex was human generated, which is really interesting psychology, and I think just highlights the fact that we can work on being better communicators to dispel misinformation.

DR. TEWFIK:

That's that's really, really interesting. I love to definitely check out that study. And it gets me to thinking about how it is that we talk to patients all the time, and we're instructed to actually try to decrease the educational level of how we speak to them. And I wonder if maybe this kind of data is showing us that maybe we should not, and that there is a risk in doing that. It's really interesting.

One of the things I think that frustrates me a lot when talking to residents, is our digital communication with one another. Um, I am in one of those generations where everything is by email. And so I email the residents and just assume that they're going to see it and they don't read their email. Um, and it boggles my mind, but I'm starting to accept the fact that my emails will not be read. Um, so it really has me wondering where is it that you guys get your information from? What kinds of platforms are you using? Is it all WhatsApp? It is, isn't it?

DR. CUNNINGHAM:

I use a pretty broad mixture of resources just for general knowledge and for my practice in residency as well. I use up to date our journal anesthesiology. I read the science and health information that's found in the Wall Street Journal. I've started using open evidence, as well as ChatGPT as AI sources and becoming familiar with those, because that's what my co-residents, my colleagues and patients are using as well. And so I try to seek out different forms to become the most well-rounded and informed that I can for my patients.

DR. HUANG:

There's definitely a level of we as residents in training want to use evidence based articles and journals. But also part of me is also looking at social media to see what the general public is kind of learning from and where their knowledge comes from. So some of that I also look into, just so that I can better understand kind of where patients are coming from.

DR. ROLFZEN:

I think I also engage with colleagues on platforms like LinkedIn. I think there's a maybe a nexus point here of of medical professionals finding a new online community. I think we're in that shift away from maybe X, Twitter and trying to figure out where that will be, but also increasingly curated medical podcasts. Um, I'll shout out the Jed Wolpaw podcast that I've listened to for his like three hundred episodes now, and that's helped me not only study for tests, but realize what else is going on in our field. And I think that's been, you know, super important because the future of reaching clinicians is meeting us where we're already having conversations. Um, and so it's great that we can all be here together today and do that and spread, um, information this way, too.

DR. TEWFIK:

So if I find a really interesting article that I want to share with you guys, uh, because it relates to something that we discussed in our lecture last week, how do I get that to you? Because emailing it as an attachment does not work.

DR. HUANG:

I, I will use my email, but I also email my co-residents and they don't see it for months. So I would say I feel like our generation typically uses like text messages more. And that's how you get like faster responses.

DR. CUNNINGHAM:

In my specific program, we've got one attending who uses like a group messaging app, GroupMe. And it's he's one of our more academic leaning ones. And so it's all the residents and him and he sends out one or two articles a week. And so that's a expected reading the next time you see him in the hospital for for discussion.

DR. ROLFZEN:

I probably look at my email too much. So I'm not good to answer this question. But, uh, the advent of visual abstracts, I think, um, has been growing over the last decade and is a quick soundbite, at least an introduction to the paper showing you what the question is, what the outcomes are, what you can highlight from the paper. It's not, um, something that is practice changing in and of itself. But I do think that, um, having an infographic has really been a helpful way to solidify, um, complex manuscripts in, in a In a digestible way.

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DR. CUNNINGHAM:

This has been a really great, informative conversation. Thank you so much for sharing your knowledge with us today, Dr. Tewfik. Thanks to my fellow residents for joining me today as well. Thanks to you, our listeners for tuning in. Join us again soon for more Residents in a Room, the podcast for residents by residents.

DR. PATRICK GIAM:

Hello ASA: I’m Dr. Patrick Giam, your ASA President. Welcome to my first Monday Morning Minute. Today, and each month, I’ll provide you with a few highlights from the Monday Morning Outreach.

First up: A member benefit. ASA is working to provide value, and so I’m pleased to share that we have launched a new, member-exclusive insurance program. This program will be particularly attractive to locums anesthesiologists, and others without easy access to group policies.

Next: Helping our communities is important. During ANESTHESIOLOGY® 2025, we hosted our 9^th annual Doctors Back to School event, where 80 middle school students heard personal experiences from ASA members and then participated in hands-on stations, including Intubations, CPR, and epidurals. Hmmm… sounds like they might be the answer to some of our workforce challenges!

And lastly, congratulations to the Louisiana and West Virginia components for winning the 2025 membership re-engagement initiative. We’re excited that ASA has reached a record number of active members and total membership, which now exceeds 60,000.

Well, that’s all I have for today. Thanks for listening, and I hope you’ll follow us on your favorite social media channels, and check out my weekly Monday Morning Outreach. Until next time, this is Dr. Patrick Giam, your ASA president.

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