key: cord-0014980-jdwtgx2v
authors: Agarwal, Anish K.; Ranney, Megan L.; Chang, Bernard P.
title: Beyond the bedside: Clinicians as guardians of public health, medicine and science
date: 2020-12-25
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.12.058
sha: 4c0151d34b65951565d081b971f175e6fde7e918
doc_id: 14980
cord_uid: jdwtgx2v

nan

Beyond the bedside: Clinicians as guardians of public health, medicine and science COVID-19 has upended clinical practice across the globe. In a milieu of shifting scientific knowledge, clinicians have been tasked with rapidly evolving their practice while defending the validity of science. Historically, clinicians have been a trusted source for the evaluation and interpretation of medical knowledge. In this "digital age" pandemic, partisan messaging, heightened awareness, and rapid transmission of information, have placed medicine in a fragile position. Providers must fight for patients at the bedside, and battle mistruths and distrust emerging from avenues far beyond hospitals or clinics. A critical re-evaluation of the role of clinicians is needed. We must protect patients from physical disease and the "disease of misinformation." Neglecting to address the latter may have profound implications for the former.

The public's use of digital technology to manage health predates COVID-19, as does social media's benefits and threats to population health [1] . This pandemic has amplified our dependence on, and difficulty interpreting, technology-mediated health information. In addition to the accelerated adoption of telemedicine and remote patient monitoring, digital platforms are playing an outsized role in communicating information during the pandemic. Americans are increasingly accessing news online (websites, apps, or social media) and as many as 50% state they've seen fake news online [2] . This distrust may reflect the promotion of pseudo-science, the sensational nature of headlines, or the lack of reliable interpretation of scientific data.

The rapid dissemination of information, whether validated or not, across the public and within medicine has complicated clinical and public health practices. Whiplash around therapies and the retractions of research publications has muddied the waters guiding clinical care [3] . Misinterpretation of the natural evolution of medical research combined with an escalating urgency has undermined the scientific process. Indeed, vaccine acceptance is mired in controversary, with up to onethird of Americans reporting skepticism in receiving one of the FDA approved vaccines [4] .

Distrust of science is also not new. The anti-vaccine movement, defunding of physician involvement in firearm injury prevention, and reproductive health are longstanding flashpoints. This pandemic has introduced an unheralded degree of suspicion and vitriol over the institution of medicine itself. Debate around treatments, vaccine development, and mask wearing occur amongst members of the public and government, but also within sub-segments of medicine. The harm caused by misinterpretations of medical data are substantial. These distractions interfere with clinical care, adherence to public health recommendations, and with the ability to conduct future American Journal of Emergency Medicine xxx (xxxx) xxx YAJEM-159683; No of Pages 2 research [5] . The need to rebuild trust, through strong, consistent clinical perspectives and evidence-based public health messaging is urgent.

A collective effort, led by clinicians and medical societies, toward a renewed commitment to science and dispelling non-scientific driven mistruths is needed. Clinicians are well-positioned to serve as patient ambassadors. Providing care, educating, and translating science into action are weaved into the fundamentals of medical training. We need to redouble efforts to communicate public health and scientific evidence to our patients. The patient-doctor relationship will be a cornerstone toward helping patients prevent infection, through clear understanding of disease risk and transmission dynamics, and to survive disease, through adherence to quarantine and appropriate treatment regimens. Particularly important is the ability to translate cutting-edge research (and its associated media coverage) into treatment plans.

Clinicians must also engage with community groups (e.g. faith based, schools, or other social networks) to provide expert knowledge, serve as a conduit for information, and translate research. We must reinforce trust in health systems, by listening to partners' needs and concerns and informing strategies toward addressing unmet needs. We can bring our awareness of community's vulnerabilities to reinforce and support at-risk groups. This pandemic has disproportionately impacted communities of color and individuals with low socioeconomic status; clinicians have a unique role in reaching out to, and amplifying the voices of, those who have not been heard.

Clinicians have been thrust into the spotlight to assist in interpretation of pandemic-related news. It is vitally important that these conversations do not stop. Effective advocacy may take place on multiple levels. Many have taken to social media to amplify their voice and interact with the public. These channels remain important due to their widespread adoption, immediacy, and ability to highlight trusted resources. The pandemic has already seen key clinician-led social media movements, such as #GetMePPE, a worldwide call for personal protective equipment for healthcare and essential workers [6] .

The pace of clinical care and research addressing COVID-19 has been remarkable. Clinicians must adapt to new threats to support the foundations of medicine. These battles have begun at the bedside and continue to the steps of the Capitol. We must be the voice of reason and be aligned to dismiss mistruths, advocate for patients, and uphold the trust in healthcare. Our responsibility is with the patients and communities we serve. To meet this challenge, it is time to step up to our role as guardians of science and public trust.

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