Addressing online misinformation with patients
Answers in Practice
By Emily Margosian, Assistant Editor , November 1, 2022
DermWorld talks to Karan Lal, DO, MS, FAAD, from Affiliated Dermatology in Scottsdale, Arizona, about how to discuss online misinformation with patients.
DermWorld: Tell us about your practice.
DermWorld: Many physicians have reported seeing an increase in patients citing misinformation, particularly during the pandemic. Is this a trend you have also observed?
Dr. Lal: I think an unfortunate side effect of the pandemic is that it instilled a lot of mistrust in health care providers among the public. People got into this mindset that they know everything and can treat themselves. They were more hesitant to seek out professional care. Once we got back in the clinic after the initial lockdown, you could really feel more tension with patients, particularly with parents who had received false information. Their children were suffering because they weren’t listening to the science. I make sure that people understand the value and distinction of the educational background that dermatologists receive.
DermWorld: Have you treated patients who have attempted at-home care based on online information?
Dr. Lal: Yes. The thing I’ve seen most are DIY fillers. A lot of people were investing in the hyaluronic acid pens, or the hyaluron pen, where they were putting filler into their lips. I’ve had several patients come in with lumpy lips that were either done at home or by unlicensed estheticians. The problem is: not only is the device not regulated by the FDA, but I also don’t know what products they’ve put in their lips. To treat them, I must figure out how to dissolve what they’ve injected. Our typical agents that we use may not even apply to these substances because we don’t know what they are.
Another common thing I’ve seen is microneedling with makeup, where people use microneedling pens to try to create a permanent makeup tattoo. The number of infections and scarring I’ve seen from that is insurmountable. It is so scary. I have several patients who now have permanent damage and are looking at thousands of dollars of laser treatments to correct it.
I’ve also had patients who have injected paraffin into their skin as fillers, which is very dangerous. People have been doing that for a few years now, but it became popular again during the pandemic when people didn’t have access to a dermatologist. I’ve seen patients who have had serious reactions to these oils in their skin, and many of them end up with significant nodules in their face because their body has basically walled off these oils and substances, and it’s hard to treat them. I’ve also seen multiple mycobacterial infections from these self-injections because people are not using sterile technique.
DermWorld: How do you approach conversations with patients citing incorrect information they’ve found online?
Dr. Lal: I try to explain my experience and my training. I did a cosmetic surgery and pediatric dermatology fellowship. I stay up to date with the literature, and I’ve also been involved with several studies for a lot of cosmetic devices and treatments. I explain all this background to them to try to validate my training and my education and emphasize that what I’m telling them is sound. I also try to hear people out and make sure they’ve had the opportunity to completely explain what they’ve heard. Then I’ll kind of do a ‘fact-versus-fiction’ with them. I really try to reinforce my experience with the available data. I often have a computer or laptop in the room with me, and I typically try to keep landmark studies on hand to show patients.
DermWorld: How do you talk to patients about unrealistic results they may see on social media?
Dr. Lal: I think it’s important for patients to realize the “before and after” pictures they see are just pictures and should mean nothing. A lot of these photos on social media may not even be representative of the person who is performing the procedure in the office, and that is false advertising. When you’re looking for a physician who performs a certain service, you want to see if there’s a trademark or any annotation of where these photos came from, and who performed the procedure. That’s probably the most common source of misinformation and false advertising that we see right now in dermatology. For example, a dermatologist may do a procedure and take before and after photos, but if they’re not trademarked or copyrighted, there are other people who are not dermatologists who may take those photos and use them as their own. Truth in advertising is a big issue. So, I encourage patients to make sure that they look for a board-certified dermatologist who has experience in the services they’re seeking.
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DermWorld: How do you use your own social media presence to educate patients?
Dr. Lal: I’m most active on Instagram, and it has been the most successful platform for me. You can make educational videos, posts, and “reels.” I also work a lot with different traditional media outlets where I serve as an expert. I can then take screenshots of the stories I’m quoted in and post them on social media with the appropriate hashtag. It’s one way of providing patients with little tidbits and pearls so they can easily find answers to their common questions that are coming from a reliable source.
I always tell patients: when you’re on social media, please look for board-certified dermatologists or the hashtag “board-certified dermatologist.” Watch their videos, see if they’ve written any articles, and write a list of questions. When you go in to see your doctor, that’s your time to ask those questions and make sure there’s truth to what you’re reading online.
Karan Lal, DO, MS, FAAD, is in private practice at Affiliated Dermatology in Scottsdale, Arizona.
