Dr. David Scales, Clinical Assistant Professor of Medicine in the Division of General Internal Medicine and Co-Director of the Qualitative Methods Unit, presented at Medicine Grand Rounds on “Beyond Medical Misinformation: A Clinician’s Guide to Distorted Health Discourse.” His presentation reframed misinformation as part of a broader ecosystem of distorted health discourse, emphasizing that clinicians must understand the information environments in which patients live. He highlighted the importance of screening for both active information seeking behaviors, which he described as a patient’s “information diet” and passive exposure such as time spent on social media. Dr. Scales underscored that the sheer overabundance of information has become a public health challenge.
Dr. David Scales
He outlined several strategies and tools that clinicians and public health practitioners can use to navigate situations where patients goals and behaviors are misaligned. Digital literacy interventions including resources like Quackwatch and lateral reading techniques can help individuals better evaluate the information they encounter. Dr. Scales also discussed the value of tracking misinformation “hotspots” using incidence-style surveillance and adapting public health surveillance models to monitor information harms.
Community-centered response studies funded by the Cornell Center for Health Equity offer promising ways to address misinformation at the local level. Dr. Scales highlighted the study featured in The Lancet Infectious Disease about getting ahead of malaria vaccine rumors Cameroon to show how macro level national trends and micro level qualitative insights can inform effective interventions. He shared early findings showing that information campaigns work best when aligned with vaccine rollout efforts and that poorly trained or unsupported health workers can unintentionally undermine vaccine confidence. He also noted that highly educated individuals remain vulnerable to misinformation when spending many hours on social media per day, as seen in persistent rumors about the malaria vaccine. Community-oriented motivational interviewing is a promising approach for aligning health behaviors with personal goals. Dr. Scales introduced the idea of an “infodemologist,” a role focused on responding to infodemics through public health infrastructure that reflects community values and preferences.
A central theme of the presentation was the role of motivational interviewing in addressing misinformation. Its empathetic and non-confrontational style helps clinicians engage patients whose perceptions of risk or health behaviors may be shaped by distorted discourse, enhancing their motivation to align their health goals and behaviors. Dr. Scales also described how online communities influence information flows. Interventions can reduce misinformation on social platforms when infodemiologists act as hosts, moderators, translators and role models. These communities serve an important infrastructural role and their responsiveness and sense of empowerment can shape public understanding.
Dr. Scales emphasized that addressing misinformation requires shifting from an individual focus to a community level discourse approach, such as managing nuance, empowering communities and pursuing systematic changes. He called for more empirical, discourse-based research to understand cumulative and context dependent effects of misinformation. Because social media functions as a mass communication system, he stressed the need for interventions that match its scale and speed.
Looking ahead, he highlighted several priorities for research and practice, including integrating information environment screening into clinical workflows, using rewrite algorithms to detect or reduce distorted discourse and expanding shared toolkits such as MisinfoRx to support clinician communication. He called for more empirical studies to understand how misinformation shapes risk perception and health behavior. His presentation served as a call to action to build public health infrastructure that can respond to infodemics, empower communities and align health communication strategies with the realities of today’s information ecosystem.