Opinion | Doctors Are Not Exempt From Knowing How to Communicate

Recently, Peter Hotez, MD, PhD, a physician-researcher whose decades-long career has focused on vaccines and tropical medicine, turned down an invitation to debate Robert F. Kennedy, Jr., a Democratic presidential candidate well-known for his anti-scientific stances, on the Joe Rogan podcast.

Since then, the internet has seen a flurry of articles in support of Hotez’s decision not to engage with RFK Jr., who has exhibited a blatant disregard for facts on a vast number of occasions (dating back to at least 2005, when he wrote a cherry-picked, conspiratorial article about the vaccine preservative thimerosal). As a physician who strongly believes in vaccines, and rigorous hypothesis testing, I am in agreement with Hotez and support his decision not to extend a platform to anyone so evidently hellbent on opposing veracity.

But the kerfuffle between Rogan and Hotez highlights a deeper, more important issue: that of health professionals’ large- and small-scale failures to effectively communicate with the general public.

While conspiracy theorists gain traction and hostility towards practitioners of rational inquiry becomes increasingly problematic, medical training institutions are continuing to prioritize the rote memorization of esoteric enzyme pathways over the practice and understanding of effective interlocution. In order to be admitted to medical school and to match into a post-graduate residency of one’s choosing, student doctors must have high GPAs and score well on a set of standardized exams that reveal little more than income status and one’s ability to retain a large number of facts for a limited period of time (a task that is, perhaps, better suited for AI).

Unfortunately, if doctors cannot successfully convey health information to their patients or the public at large, it simply does not matter what their test scores were, or how quickly they can rattle off the coagulation cascade.

Across the U.S., medical school curricula offer disturbingly little in the way of communication training and, what does exist, is usually accomplished through the use of standardized patients — paid actors with whom students have brief, pre-scripted interactions. Though the Accreditation Council for Graduate Medical Education (ACGME) has established interpersonal and communication skills as one of six core competency requirements for resident physicians to master prior to completion of training, evidence that they have done so relies on the subjective evaluations of their superiors, whose relational acumen may be no less impaired.

From mid-2020 until late-2022, doctors were a near-constant presence in national media outlets, offering round-the-clock COVID-19 data interpretation, surge analyses, and travel recommendations. Yet, notwithstanding these ever-present, well-credentialed, expert opinions, large swaths of the public were, at best, unimpressed by even the most impassioned pleas to wear masks, wash hands, and quarantine after exposure.

According to a recent study by the Pew Research Center, the public’s confidence in doctors and scientists declined sharply, following a brief initial rise, 1 year following the start of the pandemic. Of 14,497 U.S. adults surveyed from November 30 to December 12, 2021, only 29% reported having a great deal of confidence in medical scientists to act in the best interests of the public.

Surely, there are factors contributing to the distrust of science and medicine that have nothing to do with doctors’ ability — or inability — to communicate. As others have suggested, the iterative nature of scientific research does not lend itself well to a 24-hour-news cycle in constant search of attention-grabbing headlines. Still, allowing for physicians to complete their extensive training without a single course in persuasive writing or public speaking certainly isn’t helping the cause.

Communication failures between doctors and laymen in this country are not limited to mass media forums, and are hardly novel. Nearly 20 years before SARS-CoV-2 arrived on U.S. soil, the breakdown in understanding between individual providers and their patients was evidenced by a medication adherence rate for chronic illnesses of close to 50%, according to a 2003 study by the World Health Organization. Of course, a multitude of complex factors contribute to whether patients are able to pick up, pay for, and take their prescriptions. Even so, if treatment outcomes are to improve, being able to appropriately counsel patients on what their medications are for and how to take them is a good place to start.

Throughout the country, law, pharmacy, business, library, and social work schools routinely offer coursework designed to improve counseling and communication with clients. An established bastion of competent orators, Harvard Business School offers a course called TALK: How to Talk Gooder in Business and Life. The course’s designer and instructor, Professor Allison Wood Brooks, PhD, has emphasized that “the best way to sharpen conversation skills is through practice, experimentation, feedback, reflection…and more practice.” She uses a four-pronged approach called “TALK”: Topic selection, Asking questions, Levity, and Kindness, to help students become more confident communicators by the end of the semester.

Historically, many doctors have shied away from dipping their sulci into the realms of organizational psychology or deal-oriented communication methodologies in favor of a belief that scientific facts should speak for themselves. Unfortunately, as RFK Jr. and his conspiracy-driven followers have made evident, the facts are stuttering while well-rhetorized distortions and lies are charging ahead, clearly articulated.

If physicians want to have a fighting chance at improving trust and understanding between themselves and the public, in the clinic and beyond, medical training institutions will need to acknowledge the importance of acquiring effective speaking skills, and must implement measures to ensure that future physicians are equipped to handle even the most trying of conversations.

Adina Wise, MD, is a movement disorders neurologist at Mount Sinai Beth Israel in New York City. She frequently writes about medical training, healthcare policy, genetics, the brain, and neurodegenerative illness.