Conspiracy Theories, <scp>MDTs</scp> and Communication

A few weeks ago, two unrelated conversations I had with strangers in the space of 24 h, highlighted for me just how difficult it can be to communicate with someone who holds strong beliefs in conspiracy theories. The first was with a taxi driver. We started discussing current conflicts and after a few minutes of debating, he began espousing implausible ideas, including the claim that Churchill had made a secret agreement with Hitler to invade Russia. Later that same day, while taking a swim in the sea in Greece, I started chatting with another tourist. I am not sure how we got there, but at one point she was telling me about the theory that trails from airplanes are maliciously mixed with chemical compounds in order to control the weather, and that this was the real cause of climate change. Looking online, I understand that this theory may stem from discussions within a group of climate scientists who have advocated the use of geoengineering methods such as spraying reflective particles 30 miles above the earth, in order to slow global warming. Such geoengineering techniques are indeed controversial as there may be unexpected serious consequences on the weather. But the conspiracy theory goes beyond any debate on the pros and cons of this approach, picks up a kernel of reality and twists it into something incredibly farfetched and unproven. The burden of proof is then shifted on the listener. Any facts that are provided to counter the claim are dismissed as a coverup. Conspiracy theories by their nature put the onus on you to prove that they are not true. And because they are supposedly happening secretly and with malicious intent, any attempt to disprove the theory is met by the statement that it is you who don't know the facts and are not aware of the “real” information. Why am I talking about conspiracy theories here though? I guess I was taken aback by the extreme difficulty of any meaningful exchange with my two chance encounters. I felt that anything I said was met by a wall of mistrust and unshakable belief that theirs was the only truth. A truth that I felt implausible and lacking any solid evidence. I felt a complete closure to any other points of view. This led me to think about communication within multi-disciplinary meetings (MDTs). Fruitful ILD MDTs (and indeed any other type of MDT) are built on effective communication, starting from mutual trust. Trust that accurate and thorough clinical information is provided for each case, and trust in an open-minded discussion of differing interpretations of clinical, radiological and pathological information. It also requires willingness to listen to each MDT participant and their reasoning, based on clinical experience with similar cases, knowledge of the relevant literature and overall expertise. At their best, MDTs will provide insights that go beyond any individual contribution, as the discussion between participants often triggers novel insights that would not have emerged in isolation. At their worst, MDTs risk becoming echo chambers dominated by the most vocal or forceful participant. Rigidly held views can bring discussions to a standstill, especially when there is an unwillingness to challenge one's own views in the face of evidence or experience of others. Although conspiracy theories are rarely aired in MDTs, a similar kind of rigidity and absolute conviction that one is right and all others are wrong, can be damaging. Openness, mutual respect, willingness to genuinely consider different perspectives, and constant commitment to rigorous clinical reasoning are essential for the success of an MDT. The author declares no conflicts of interest.