07. Misconceptions, myth-busting & basic choices.

Table of content: 1. Introduction 2. What are misconceptions? 3. How common are they? 4. Let’s talk osteoarthritis 5. Internet? 6. Onwards to myth-busting 7. Conclusion

We are what we can and can not perceive;

An excellent example of this prevails famously among pediatric clinicians when they say, “never disregard what a mother says”, this in no way declares a mother’s opinion superior to a clinician’s judgment, but it clearly shows what pediatricians have long realized that a mother’s instinct, and her perception, quickened by love, makes her a keen observer, making her intuition and concerns about their child’s health irrefutably telling.

But, Fairness lies in realizing that neither a patient nor a clinician is free from errors of perception and even gaps of competence.

In this blog, we’ll see how common myths and misconceptions are, and question if myth-busting can help at all.

Just keep in mind that we can’t use the word ‘misconception’ to describe every kind of knowledge gap; be it common or scientific knowledge. We’ll frequently use the words ‘misconceptions and myths’ throughout this article for the sake of simplification.

What is a misconception?

A compulsory google search shows, that misconceptions are faulty beliefs due to a faulty understanding of the subject/concept.

To simplify, the word misconception comes from the verb ‘to conceive’, meaning; it’s a conception of a new and erroneous belief based on a misperception of a concept.

The problem with misconceptions is that they are often quite persistent, and they can seriously interfere with someone’s ability to learn.

Let’s take a few common examples;

1. One human year is equivalent to seven dog years

2. Chameleons change color to match their surroundings

3. Sugar makes children hyper

4. People use just 10 percent of their brain

5. Birds, fish, and insects are not animals

Our lives are riddled with such myths, even to a point that these have crept into language and daily communications, and social discussions.

Not only common knowledge, but scientific knowledge is no stranger to such misconceptions, For example; even science students believe that we have only five senses, or that humans evolved from apes.

Diving deeper,

1. Joel Michael states that among (approx. 2000) medical students 40% believed that tidal volume is fixed and that it can not increase if breathing frequency increases (as occurs during exercise). (here) Interestingly, a few students held this view strongly enough to defend it with the ‘textbook’ definition of tidal volume (as it’s defined as the amount of air that moves in a single breath at rest, and is ‘fixed’.)

2. Morton et al. observed that a significant number of exercise physiology and biochemistry students, at various levels of knowledge, had misconceptions about 9 out of 10 tested topics and surprisingly 8 out of 9 misconceptions prevailed throughout the degree program.(here)

The following quote from Morton et al gives us insights into the structure of our education system from which these misconceptions might arise.

Fig., showing the tested topics (green highlights shows topic that improved with traditional teaching methods, with still some room for improvement)

Let us consider Osteoarthritis,

It is a largely prevalent and disabling condition, particularly among the elderly population, and even many clinicians and their beliefs are filled with misconceptions and misperceptions about osteoarthritis, which translates to widespread patient beliefs(myths) about the condition.

Considering the implications of patient beliefs, Bunzli, Samantha et al. conducted a qualitative study that documents various misconceptions about knee Osteoarthritis,(here)

Finding of which highlights that,

And many such concerning thoughts and conversation pieces such as,

The authors conclude that;

Indicating the impact of incorrect beliefs on decision-making, which in some cases can cause more harm than good. Such as falling for seemingly convenient & effective; yet unlicensed interventions, such as Stem Cell treatments and products,(here) ‘Findings like these suggest that there may be an urgent need to improve patient-clinician communication so that they do not inadvertently perpetuate misconceptions that patients present with and to correct misconceptions among clinicians that are being passed on to their patients.’

Hyun-E Yeom, in a study of symptoms, aging-stereotyped beliefs, and health-promoting behaviors of older women with and without osteoarthritis(here) Found that older women with osteoarthritis showed strong agreement with the phrases “It is hard to cure symptoms in old age” and “Health care providers need to concentrate on curing the disease rather than on dealing with symptoms.”

Conclusion which the author states;

Making it an active moral duty of clinicians involved with similar populations to dispel such misconception and promote activity and health-positive behaviors and lifestyle modifications alongside symptomatic care.

What about the Internet?

With growing access to internet facilities and affordable technology, the Internet has become a particularly appealing source of information and advice for people, especially among a lot of young people seeking information about sensitive or stigmatized illnesses, and people suffering from chronic painful conditions.

But, is it free from myths and misconceptions? No!

Simple Logic leads us to believe that the internet must be full of myths and misconceptions due to 3 basic reasons;

1. Most health and fitness brands are advertisement-forward instead of being evidence-based. Massive cash cropping in the health sector leaves it susceptible to promoting non-evidence-based products and advice that the general population readily accepts and incorporates into their lives. As most of this content comes with shallow promises like ‘quick fixes’, ‘affordable health’, ‘elite spirit’, etc.

2. ‘Fitness influencers’ amass an exceptionally large audience on social media without bearing any responsibility for the information they present of themselves, Trust factor plays a crazy role in glorifying any opinion they might have into a piece of legitimate health advice, which is more likely doesn’t follow current evidence or any evidence at all, as most of the social media industry functions on ‘what’s trending, sells!’.

3. Physicians, Surgeons, and various other Healthcare providers, who are considered to be reliable sources of evidence-based information and health-related facts, aren’t even free from misconceptions themselves, many not being evidence-based as well. However, this only includes a minority of clinicians, a few of whom have a solid internet presence; enough to be actively strengthening many myths and misconceptions that satisfy their personal and professional biases.

This doesn’t mean to encourage distrust in healthcare workers as; clinicians still are the most reliable source of valid and scientific health-related information to the general population.

But, it also doesn’t discount the fact that clinicians are humans and the presence of misconception is just an undeniable complicacy of having to face neverending advances in science and scientific literature which is understandably difficult for everyone to keep up with.

Finally, Let’s discuss the role of phrasing sentences a certain way while explaining topics prone to misconceptions and surrounded by scary narratives.

As clinicians, we often use Instructional and informational pamphlets explaining medical conditions, treatments, potential side effects, nutritional habits, lifestyle modifications, etc. But, do we realize what it means for the understanding of the populations we target? Written texts are one of the most common sources of medical information, and these documents must be worded in ways that become easy to comprehend for everyone, especially the elderly who are arguably the largest consumers of healthcare services, as a misunderstanding of these documents can have major consequences.

Not to forget biases in understanding, As It is well-documented that human beings of all ages selectively interpret new information in a manner that is consistent with one’s existing beliefs. For example, information that is consistent with existing beliefs attracts one’s attention more readily and is more easily remembered than information that is inconsistent with existing beliefs. Thus, one reason individuals can maintain faulty beliefs is that they simply fail to notice and/or remember disconfirming evidence. (here)

Additionally, older adults tend to remember central information and forget the associated context (here) Following which Elizabeth A.H. Wilson(here) hypothesize that older readers of health-related material might actually forget the presence of negation in a sentence and thus remember the statement’s opposite meaning, i.e,

A negatively worded statement such as ‘‘Taking aspirin does not decrease your risk of catching a cold.’’ might be misremembered as ‘‘Taking aspirin decreases your risk of catching a cold.’’ which in certain instances can have dire consequences on their health.

The author additionally concludes that ‘The inclusion of the word ‘‘not’’ in medical instructions may backfire when a patient remembers a sentence’s main idea but is unable to recall its contextual details such as valence. Because older adults have especially fallible source memories, and because they are especially likely to believe that familiar information is true, they are particularly susceptible to this effect.’

This takes us to Myth busting!

A vastly popular and widely used strategy where, Health educators take on the role of medical myth-buster and directly challenge misconceptions through the identification of common myths and the presentation of disconfirming information, like a few repetitive lists of common myths and misconceptions that highlight the misinformation about a disease or condition.

No doubt it’s an excellent patient education strategy, but as it relies on context for understanding, we must know where it can potentially fail.

And ask ourselves the question, Does it work as expected for all?

Pamela I. Ansburg & Cynthia J. Heiss, in their paper (Potential Paradoxical Effects of Myth-Busting as a Nutrition Education Strategy for Older Adults) (here) similarly states:

The authors additionally conclude that ‘medical myth-busting may have counterintuitive and counterproductive effects for the education of older adults. Myth-busting may, at best, be an ineffective way to correct older adults’ misconceptions about health and, at worst, may in the long-term, serve to reinforce faulty beliefs.’ This could be attributed to The illusion of truth effect, that is, the more often an individual encounters a message, the more likely it is that the individual later will endorse the truthfulness of the message.

Thus it becomes fundamentally important to keep in mind these facts and to consider the cognitive status of the patients (especially elderly patients) before engaging in myth-busting, and even then using positively worded non-ambiguous statements might be the best choice.

Additionally, you can employ the Kieran O’Sullivan test, wherein you could just try “Asking your patients to describe how they would explain the consultation findings to their family when they get home”. It’s an empirically sound way to assess what your patients take with them after any session.

To conclude,

Even if you are chronically ill, acutely ill, or take care of those who are, misconceptions are scary. But, what scares you doesn’t need to control how you live and feel about yourself, and if you found it on the internet, it probably is someone’s selling point. Your healthcare providers know better than what you can conclude from all the information available in a few web articles.

Seek help, Talk and Grow.

Cover photo by Tima Miroshnichenko from Pexels

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Disclaimer: All the structures and context must be clinically assessed, this blog is in no way a substitute to a clinical assessment and all must consult a physiotherapist or a physician in any such conditions.