Category: COVID-19

“Connecting” With the Vaccine Hesitant Patient

Check this out. What you will see is a really well-written piece on how a physician can have a meaningful conversation with a patient who is hesitant to get vaccinated herself, and/or is hesitant about getting her children vaccinated. The message here is a simple one, but it is lost on many of the physicians with whom I have conversations in my On Doctors’ MindsSM project.

The punchline is, while most doctors try to convince such patients of the vaccines’ safety and efficacy by talking “science,” this doctor’s interaction with this patient, over several different occasions, is actually the right way to do it. Sure, the practitioner has to be patient (pun intended) enough to penetrate the diffuse “I’m just going to wait and see” objection that so many patients offer. BUT. This patient’s reason for eventually breaking down and following the doctor’s vaccine recommendation, “You saw me for me,” is genuinely profound. Understanding a patient’s psychological backstory here is essential to communicating at a meaningful level that often, as in this case, has nothing to do with the “science.”

Bottom Line. So what we actually have here is a special case of Salesmanship 101. Listen carefully before you start talking. Patients recognize the hackneyed, and to them irrelevant, science-based standard speech that many doctors have developed about the COVID-19 vaccines, and just tune it out.

There is a general principle here that merits some consideration!

COVID “Treatment” is About to Get Interesting

Check this out. What you will see is a write-up that is interesting in several different ways. First, as the writer tells the story, the interest surrounding Molnupiravir, Merck’s much anticipated therapy for COVID-19, has captured analysts’ focus far more than the overall quarterly performance of the giant drug company. How those two factor will converge in quarters to come will be fascinating to watch.

Second, intervention decisions related to COVID-19 will get more complicated, and thus more interesting, when this product is approved. Sure, frontline for the foreseeable future will remain the vaccines. Molnupiravir’s role would seem fairly straightforward, i.e., in the treatment of compromised patients with mild to moderate disease. BUT. The possibility of using the product for postexposure prophylactic therapy could substantially increase the patient pool. 

And where will the monoclonal antibodies fit in as all of this gels? And what other forms of therapy will become available that will need to find their way into the mix?

Bottom Line. The general take on the situation is that COVID-19 and its variants will be around for a long, long time. Expect that the armamentarium of agents available to prevent and to fight the infection will continue to evolve. And for the developing pathways through that armamentarium to have a substantial impact on the economic fortunes of the companies that develop and market them. 

Let’s Give “Breakthrough Infections” a Break

Check this out. A dollop of common sense here. Words are always important. We have sort of known all along that the specific words we choose to make a point can be our best friends or our worst enemies.  But the COVID-19 pandemic has given this concept new meaning. Think about the word “mandate.” As in “mask mandate” or “vaccine mandate.” In both phrases, the use of the word mandate is (has been made to be?) inflammatory, to put it mildly. Prior to the pandemic, the primary use that I recall of the term “mandate” was when a politician won an election by a large majority and declared that he had received a mandate from the electorate. In the good old days, a mandate was a good thing.

For those of you interested in getting a more erudite view of this topic, you might like to tap into this book. What you will see is a thoughtful review of how words can be crafted in such a way as to take advantage of such behavioral economics principles as biases and heuristics, and in turn can be used to influence desired healthcare attitudes and behaviors.

Now we focus on the point of the article referenced here. The use of the term “breakthrough infections” is unfortunately providing evidence for anti-vaxxers to use in making the point that the “vaccines don’t work.” Unfortunate since, as I have noted before, most people originally interpreted “90%” efficacy as “works for everybody,” responding to the behavioral economics principle of “rounding,” when in fact, it clearly means something very different. And then there are “little details” like the fact that most of the “breakthroughs” are milder cases, with very few hospitalizations or deaths. 

Bottom Line. Is it too late to undo the public health damage being done by these few words? Probably! As a wise teacher once taught me, “Until you say them, you are the master of your words. After you say them, they are the master of you.”

BUT. Hopefully going forward, we can avoid the setting of any more semantic traps which would likely contribute to even more lives being lost to the coronavirus.

AND. More generally, we hopefully will come to understand the emotional impact of words and how to work with them to society’s public health benefit rather than to its detriment.

Can Physicians Change Vaccine Hesitant Patients’ Minds??? Nah!!!

Check this out. What you will see is some mildly interesting stuff concerning telehealth. Skip over that and go to the section on VACCINE HESITANCY. 

There you will find some interesting numbers. More specifically, you will see that 52% of physicians believe that they need 2-3 conversations with patients to change their minds about vaccinations, BUT 67% of physicians believe that most patients’ minds can’t be changed. 

Put together, these numbers would support what I have been telling our On Doctors’ MindsSM subscribers based on my recent conversations with physicians, and that I also noted in a recent post.  That is, almost a year into vaccine availability, many doctors are largely giving up on evangelizing the COVID-19 vaccines with the unvaccinated. Why? In summary, they see time spent on these efforts as wasted, and they simply don’t have the time to waste. Put another way, doctors believe that anybody who hasn’t gotten vaccinated after a year is not likely to do so in the near future, no matter what their HCP says.

Bottom Line. The plot thickens. It should be noted that with the approval of new booster protocols and pediatric vaccinations, this whole dance is going to start up all over again. 

My bet? People that are already “fully vaccinated” should be ready to get their third shot. No problem.

On the other hand, how people will feel about getting their munchkins vaccinated will be interesting to watch. New objections? Same old? We shall see! 

What are the Appropriate Boundaries for a “Concierge Practice???”

Ah, to be a concierge internist in Boca Raton, FL. Yup. The website for one such physician is the source of the swipe art pictured above. Idyllic, right? But maybe not so fast! Check this out.

In a Boca Raton concierge practice, you are likely to encounter the kind of patient talked about here. A patient closing in on 90 years of age who apparently had a bad fall, didn’t know why and wanted to come into the office to get “checked out.” Understandably, the physician believed, and explained to the patient several times, that “checking out” here was going to require imaging, and thus a trip to the hospital. Not surprising that the patient didn’t want to go to the hospital during a pandemic, but sometimes you gotta do what you gotta do. 

Here’s the punchline. The patient wants his concierge fee money back because the doctor was not living up to his contract, which promised “same day” office visits for “acute” situations. Somehow, the line of reasoning that said that heart attacks, automobile accidents, possible brain injuries, and similar cases were not the kinds of acute problems that were under discussion here was lost on this patient. 

Bottom Line. Once again, this discussion had me scratching my head. On one side, we have “contract wording.” On the other side, we have “rational thinking” and “common sense.” Somehow, which of those should be the primary consideration in a situation like this seems obvious.

But apparently not!

Please Listen to Me!!!

In my most recent On Doctors’ MindsSM Executive Summary, I surprised some of our subscribers by reporting out that in the COVID-related conversations that I had with office-based physicians in September, most of them told me that while a majority of their patients had already been fully vaccinated for COVID, they had basically stopped trying to convince the remainder of their patients to get their shots. Why? Because, the doctors explained, after a year of preaching the gospel, they felt that continuing to try to convince holdouts was, quite simply, a waste of their time. 

But check this out. What you will see is a doctor’s recounting of a conversation in which he tries to convince an unvaccinated couple to get their shots. You will see that the doctor is not only wasting time here, but getting “hurt more than I care to admit.” How? By having the patients include this physician, by implication, as a perpetrator of the great COVID/VAX scam that they believe is being perpetrated in America.

Bottom Line. Read this doctor’s post carefully. Think about it. Digest it. If you were this physician, how many more traumatic encounters like this would it take to shut down your vaccine evangelizing?

I’m guessing not too many! 

Is a Pandemic About “War” or “Natural Disaster???”

The answer actually matters. Check this out. Here we have a blogging cardiologist arguing that we should not be making the mistake of dealing with COVID as if we are in a war with the coronavirus. Wars give governments pervasive powers and often turn citizens against each other. Rather, we should deal with the pandemic as a natural disaster. Something that we expect citizens to ban together to deal with, rather than fragmenting into factions. And the government to focus on helping the citizenry, rather than issuing mandates.

Bottom Line. Interesting. Metaphors can have very important and pervasive psychological consequences. See how we have been (mis!)-handling COVID-19 for reference!

“No One is in Charge” of US Public Health

Check this out. What you will see is a summary statement on the COVID pandemic, and more generally on the state of public health in the United States, from a blogging psychiatrist.

Doubtless he is correct in his perception that millions of pious Jews prayed to God during the recent Days of Awe that He extinguish COVID-19. Sadly, the blogger has come to conclude that the results of the last 19 months have strongly suggested to him that “No one up there is listening or responding.”

Likewise, he opines that no one on earth is really running public health either. In the US, is it the CDC or the FDA? Nope! The President? Nope again! WHO? Nah! Tony Fauci seems like the answer that is closest to the truth, and despite his expertise and constant TV appearances, that’s just silly.

And what comes out of this? Constant confusion! My wife and I were very clear that, according to Biden’s pronouncement and what I heard from my Volunteers In Medicine physicians, everyone who got Pfizer #1 and #2 should get a booster shot eight months thereafter. Off we went to the pharmacy department of our local grocery store(!), and got the shots. No questions asked. Two weeks later, we find that the FDA is now only recommending the shot for the immunocompromised and those over 65 (Thankfully, Casey and I are in the latter group and not the former!), with the CDC yet to weigh in, the Moderna and J&J vaccine boosters still up for grabs, and Dr. Fauci labeling the FDA vote against universal boosters as “not the end of the story.”

Bottom Line. Both in the heavens and here on Earth, the fact that no one is really in charge of public health is a problem that has been brought into focus by the COVID-19 pandemic.

And now it needs to be fixed!

The Covid Vaccination Struggle and “Market Forces”

In my most recent round of 10 On Doctors’ MindsSMmonthly conversations with physicians about the impact of the pandemic on their private practices in primary care, cardiology, oncology, etc., I have been asked by several clients to talk about the impact of “market forces” on vaccination acceptance among their patients.

As I predicted in a previous post, the Pfizer vaccine receiving “FULL FDA APPROVAL” didn’t matter in a single practice with which I conversed. Patients simply have no idea of the difference between “Emergency Clearance” and “FDA Approval.”

For practices with large numbers of working patients, the possibility of a “VACCINE MANDATE” was predicted by my discussants to have a significant impact, although not without a lot of rancor as the picture above, on the left, would suggest.

By far, the best conversation I had on the topic of convincing patients to get vaccinated was with a cardiologist in the Bronx, who actually was the first US physician to contract COVID himself at the beginning of the pandemic. He tells skeptical patients that they are right.  The vaccine is a hoax, as is the pandemic. The 600,000 people who have reportedly died of COVID were actually taken to Area 51 in Nevada, where they are being kept against their will. Etc., etc.  At the end of this riff, he asks patients if they believe all of that. Most, not surprisingly, say “No!” His retort? “Then your only choice is to get the vaccine.” One patient shot back that he was going to have to “Evaluate the science further.” To which the cardiologist, obviously no shrinking violet, responded, “You’re a truck driver. How are you going to do that?” Sort of the current situation in a nutshell! 

But check this out. An ICU nurse’s graphic reminder that when you show up at the ER gasping for air, there are no more choices. Everything available for treatment, including intubation, will basically be forced upon you. No volition. No more “bodily autonomy.” 

Bottom Line. One thing that my discussants are telling me this month is that the only “market force” they have seen motivate a recalcitrant patient to get the vaccine is actually seeing someone close to them die of the disease. 

Question. How can we synthesize the impact of that horrendous but impactful experience and get it into widespread public distribution???

Love Vs. Vaccine Mandates

May we live in interesting times. Check this out. What you will see is my friend Jane Sarasohn-Kahn’s blog post which further develops a theme I wrote about recently. In my post, I talked about the PSA offered by Pope Francis, in which he described getting the COVID vaccine as “An act of love.” Here, Jane notes that the Catholic Health Association has mounted an entire campaign wrapped around the notion of getting vaccinated being a way to “Love thy neighbor.”

AND. As I wrote this on September 9th, a clearly perturbed President Biden announced that he was “out of patience” with the unvaccinated, and proceeded to issue a mandate for almost 100 million people to get vaccinated. Federal employees, those doing business with the Government, employees of large corporations, etc.

Bottom Line. An interesting juxtaposition of events. A message based on love and a Presidential mandate. Will these forces combine to get the hardcore unvaccinated to take the plunge? What will the percentage of success be? How quickly will all of this unfold?

Stay tuned!