From screen to exam room: Spanish clinicians reveal the hidden toll of health misinformation
Imagine arriving at a hospital for a necessary operation and telling the surgeon that you have decided to cancel because an online video warned that anesthesia would be used to kill you. Or being a nurse and hearing a patient insist that a vaccine designed to protect against a deadly virus actually caused sterilization. These are not hypothetical anecdotes; they are everyday realities for healthcare professionals, according to a new study published in Frontiers in Medicine. The study, “The hidden cost of health misinformation: distrust, treatment refusal, and the burden on healthcare professionals,” by Daniel Catalan-Matamoros, Mariola Moreno, and Carmen Peñafiel-Saiz, draws on detailed questionnaire responses from 26 healthcare professionals practicing in Spain. It explores how false and misleading health content—misinformation shared without malicious intent and disinformation deliberately engineered to deceive—has migrated from social media feeds to the consulting room. The findings reveal that clinicians are spending significant portions of their working lives not only diagnosing and treating disease, but also undoing the work of algorithms that have filled patients’ minds with false beliefs. This new burden is taking a serious toll: participants described emotional exhaustion, eroded trust, strained communication, and direct refusals of evidence-based treatment. The authors argue that misinformation has become a defining challenge of contemporary clinical practice, one that cannot be solved by individual clinicians alone. They call for better training, more time, and a broader understanding of misinformation as a public health problem that reaches its most damaging point at the bedside.
Health misinformation itself is not new, but the digital ecosystem has changed its scale and speed dramatically. Social media platforms are engineered to maximize attention, not to ensure accuracy, and their recommendation algorithms often create echo chambers in which users are repeatedly exposed to claims that reinforce their existing beliefs. The concept of “data voids”—search queries with little or no authoritative content—further explains how misleading material can fill gaps and gain prominence. The COVID-19 pandemic was a landmark moment: the World Health Organization described the accompanying “infodemic” as an overabundance of information, some accurate and some not, that made it hard for people to find trustworthy guidance. Public figures and wellness influencers, often with no medical qualifications, gained large followings on TikTok and Instagram by offering simple, appealing answers to complex health questions. While researchers have extensively documented the widespread prevalence of health misinformation on social media, measured its association with vaccine hesitancy, and analyzed public attitudes of distrust, much less research has examined how frontline health professionals experience these same dynamics in their daily practice. This study was designed to address that gap. The investigators employed a qualitative descriptive design, using an online questionnaire with 11 open-ended questions. Semi-structured interviews were administered in written form, allowing participants to answer asynchronously and at their own pace. The sample included 26 healthcare professionals practicing in Spain: 12 nurses, 5 physicians, 6 nursing assistants, 1 midwife, 1 health management staff member, and 1 retired professional. Ages ranged from 28 to 75, with a mean of 50, and women made up 76.9% of the sample. All participants had at least one year of direct patient contact. The data were analyzed thematically by two health communication experts following the method of Braun and Clarke, with manual coding chosen to preserve nuance and context. The analysis yielded five major themes that together describe the journey of misinformation from the digital sphere into the heart of clinical care.
The first theme to emerge from the analysis was the landscape of misinformation: where patients get their health information and what kind of content most often leads to problems in consultations. Participants painted a picture of a patient population increasingly dependent on social media platforms, search engines, influencers, and word-of-mouth from non-expert sources. One nurse, aged 57, said with evident frustration: “They trust Google more than medical information.” A 35-year-old nurse observed that patients “believe more what they see or hear than what professionals tell them in many cases.” Another described patients’ information as “uncontrasted”—that is, never checked or verified against reliable scientific sources. The term “pseudoscience” appeared repeatedly in the responses. The topics that create the most conflict are strikingly consistent. Vaccines were the most frequently mentioned area, including COVID-19, influenza, and routine childhood immunizations. One nurse described encountering patients who were “convinced that the COVID vaccine had caused them irreparable damage (sterilization, for example).” Antibiotics were another common battleground: patients might demand antibiotics for viral infections or refuse them entirely because of rumors about side effects. Some professionals mentioned nutrition misinformation, particularly around fad diets and miracle weight-loss products, though these accounts were less detailed. COVID-19 conspiracy theories, however, were common and potent. A midwife highlighted that misinformation is often not innocent; it can be deliberately spread by people with financial or ideological agendas, and she mentioned “doulas with economic or ideological interests behind them” as an example. The pandemic was described as a turning point. After COVID-19, clinicians said, patients became more confrontational, more suspicious of institutional authority, and more willing to challenge medical advice based on things they had seen online. This new information landscape, the researchers note, means that a patient may have already “made up their mind” before walking through the consulting-room door, making the clinical encounter an argument rather than a conversation.
The second theme concerned the erosion of trust and the clinical friction that follows. The therapeutic alliance—the partnership between a clinician and a patient built on mutual confidence—is one of the foundations of good medical care. The professionals in this study saw it being undermined every day. They reported that patients who have absorbed misinformation approach appointments with suspicion, respond defensively when their beliefs are challenged, and question not only specific recommendations but the clinician’s entire credibility. A nurse described the need to constantly correct misinformation as “exhausting.” A 75-year-old physician said the infodemic “distorts the doctor-patient relationship a lot, as it generates distrust and countertransference,” meaning that clinicians themselves develop emotional reactions toward patients that further complicate communication. A 28-year-old resident said plainly that “misinformation makes the patient suspicious and distrustful regarding the decisions you make, leading to poor communication.” Another nurse argued that when patients arrive misinformed, it creates an “impossibility of doing [their] job well,” because their clinical decisions are constantly questioned and their professional judgment is treated as just another opinion. The most alarming consequence of this eroded trust was the refusal of evidence-based treatments. A nurse reported the case of a patient who refused a surgical intervention because of fears and misinformation about “not waking up after anesthesia.” In this case, the problem was not ordinary surgical anxiety but a set of conspiracy theories and unverified anecdotes circulating online that portrayed anesthesiologists as executioners and medical procedures as traps. Other participants spoke about patients who rejected conventional treatment in favor of homeopathic products, despite clear evidence that the alternatives were ineffective for their conditions. A retired professional said vaccine rejection was a frequent occurrence throughout their career. The researchers interpret these refusals not as autonomous, informed choices but as the consequence of a polluted information environment that systematically exploits fear, distrust, and cognitive biases. Patients who might benefit from life-saving preventive care are instead persuaded to avoid it by content designed to capture their attention and confirm their worries.
The third and fifth themes revealed how clinicians respond to this challenge and how unprepared they feel. When asked what strategies they used to counter misinformation, participants described a repertoire of improvised approaches, centered on evidence, data, and respect. Some said they “reason with data and evidence,” citing meta-analyses, scientific articles, and clinical guidelines. Others leaned on “scientific evidence,” “facts,” or “tangible results”—for example, showing a patient their measured blood pressure or laboratory values. Many recognized that the way information is delivered matters as much as the content. A midwife described her approach as “information, respect, non-imposition,” pointedly avoiding confrontation. A 75-year-old head of medical services said it was important to avoid “arrogance and dogmatism” when dealing with patients whose beliefs are rooted in fear. Yet these strategies often hit a wall. Several participants expressed deep pessimism about the possibility of changing minds. One doctor said their role was “not to convince anyone,” essentially giving up on persuasion in order to preserve some semblance of relationship. The head of medical services used a striking metaphor: convincing an anti-vaxxer, he said, is like “convincing a Christian that God does not exist.” This sense of futility coexists, however, with a powerful sense of mission. Participants widely agreed that healthcare professionals have a fundamental role in the fight against pseudoscience. They described themselves as educators, guardians of evidence, and clarifiers of truth. A nurse insisted that professionals “should carry out health education based on evidence,” and another argued that they should “be on social media and in the media giving truthful and evidence-based information.” A retired professional said the role was to “educate society, inviting them” to reliable sources. But this educational mission is built on sand. When asked about their formal training in health communication or media literacy, the vast majority said they had none. Many simply answered “No.” Some had tried to educate themselves: one nurse said, “I have received training, I have looked for it on my own,” and another said they had “read up on the subject.” None had received systematic preparation, and their debunking work was therefore driven by intuition, personality, and personal effort rather than by established professional competencies.
Taken together, the findings support a broader conclusion: misinformation is not merely an online phenomenon or a topic for media regulators; it is a structural determinant of health that now shapes clinical practice, patient behavior, and public health outcomes. The authors of the study tie their results to current debates about the crisis in primary care, where citizen disaffection and overburdened services make patients more susceptible to anti-scientific messages. They also introduce the concept of “infoxication”—the overabundance of unfiltered health information—which creates a false sense of expertise and undermines the patient’s ability to weigh risks and benefits. In this context, the clinician’s task is no longer simply to diagnose and treat, but also to act as a media educator, an epistemic authority, and a psychological support system, all within consultations that are often too short for the task. The consequences are serious. When patients refuse vaccines or abandon proven treatments, they are not only placing themselves at risk; they also contribute to broader community health threats and deepen the frustration of health professionals. The authors argue that this burden cannot remain invisible. They call for a systemic response that includes integrating health communication and media literacy into medical and nursing curricula at university level, developing specialized training for practicing professionals, and acknowledging debunking as a legitimate and time-consuming clinical activity. They also recommend broader public-facing initiatives to promote health literacy, so that citizens can critically evaluate the information they encounter online. The authors cite evidence that specific, structured educational interventions in health communication have positive effects on clinicians’ ability to manage misinformation and build trust in communities. The study, however, is not without limitations. The sample was small and self-selected, with an overrepresentation of female professionals and nurses, and all participants worked in Spain, which may limit transferability to other health systems. The data are self-reported, which means recall bias and social desirability bias cannot be excluded, and the study does not include direct observation of actual consultations. The qualitative design was intentionally exploratory, and it does not attempt to measure the frequency of misinformation-related refusal or quantify the toll on professionals. Nevertheless, the richness and consistency of the narratives provide a compelling account of a problem that many clinicians already know all too well. As one participant said, “The problem is not just the misinformation itself, but that people don’t have the tools to distinguish reliable information.” Until that changes, the hidden cost of health misinformation will continue to be paid, daily, in examination rooms and hospitals, by professionals and patients alike.
