Category: On Doctors’ Minds

Starbucks, DC Physicians, and COVID-19

As you all know, I have been carefully studying various approaches to convincing people to get vaccinated against COVID-19. My monthly conversations with physicians in my On Doctors’ MindsSM research project have been revealing that for many doctors, continuing to try to convince their unvaccinated patients to get the shot is now seen as a waste of their time and potentially offensive to some patients.  SO. They have stopped.

Conversations with clergy reveal that while some are willing to make a case from the pulpit for vaccination because they believe it is the moral thing to do, others want to stay clear of the political overtones that have unfortunately come to accompany this issue.

Joe Biden’s attempts, ranging from daily entreaties to controversial mandates, have at this point become old news, court cases, or both.

But here is a new one. Physicians offering to run discussion groups at coffee shops to present the efficacy and safety of the vaccines to groups of people who are not even their patients.  Interesting. Will the casual setting and the cup of Starbucks help to seal the deal? 

Bottom Line. Think about this one for a minute. If we have learned anything about the vaccine-hesitant over the last year, it is that simply talking “science” is unlikely to convince them to get their shots. And that’s true whether the people talking science are scientific experts or even their own physicians.  Why would these physicians, well-intentioned though they might be, be more successful using the same approach?

But wait! There actually is a possibility of a good outcome here. Think about it for another minute. Those people who would be willing to show up for such discussions must have at least a modicum of openness to getting vaccinated. AND. In good old “peer influence group” fashion, a skilled moderator might be able to facilitate these people talking each other into getting vaccinated by exploring and overcoming their shared objections. That might work.

As long as these doctors are smart enough not to just “talk science!!!” 

“Hazardous” Yes and No Questions

Check this out. What you will see is a great riff by a psychiatrist on how hazardous yes and no questions can be to a relationship. Or even to a conversation.  So many times when you get a curt yes/no response, what the responder actually means is “Yes (or no), but…..”

The plot thickens. Ask a person a series of yes/no questions, and the thought process behind the answers becomes more and more stilted. And more and more information gets left on the table.

AND. It is fairly easy to see that repeatedly being subjected to that kind of prosecutorial questioning can have a negative effect on interpersonal relationships. 

Over the course of my 50-year career collecting information from physicians for my pharmaceutical company clients, I have increasingly moved from “interviews” to “conversations” for exactly the reasons talked about in this article. Only by using phrases like Dr. Adelman is recommending (“Talk to me about….” “Catch me up on…” “I’m all ears”) can we understand the whole story that the discussant wants to share with us. Only by using these phrases can we understand the salience of individual themes to the discussant. What comes up first? What gets talked about the longest? And by listening carefully to the story being told, we can also understand its overall emotionality, as well as the emotions engendered by various parts of the story. 

Bottom Line. If you really want to understand what someone is thinking, don’t ask them questions. Let them talk!

“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!

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! 

Telehealth Use Up, Patient Satisfaction Down!!!

Check this out. What you will see is common sense as it applies to telehealth. Quite simply, the pandemic hastened the proliferation of telehealth platforms and of physicians ready, willing and able to use them. The fact that third-party payers, in many cases for the first time, compensated doctors for telehealth visits was a significant driving factor here. Just so, patients seeking safety and convenience stood ready to try telehealth visits during the pandemic.

BUT. Challenges in actually using the telehealth technology reduced patient satisfaction, as did confusion about treatment costs and lack of a “provider details.” Also, rather common sensical is the fact that telehealth is seen as being more satisfactory by the relatively well than by those in poorer health, who are looking for more support from their physician interactions. 

Bottom Line. All of these J.D. Power findings line up rather nicely with the results of my On Doctors’ MindsSM conversations, wherein doctors are telling me month after month that it is the less complicated, follow up patients, and those demanding special handling in terms of safety and convenience, who are now the only ones getting serviced through telehealth platforms. Especially for specialists, the loss of direct physical examination and patient relationship management inherent in telehealth visits causes most doctors to far prefer in-office patient visits. 

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???

Does “Confidence” Cause “Action???”

Here’s an interesting one. A recent Harris Poll indicated that formal FDA approval of Comirnaty increased respondents’, both vaccinated and unvaccinated respondents, “confidence” in the vaccine. Interesting thought in and of itself. Reading this left me to ponder how many people could outline, even at the 20,000-foot level, the differences in the hurdles that a vaccine has to clear in order to obtain “emergency approval” versus “FDA approval.” I certainly couldn’t and look at what I do for a living!

The plot thickens. According to this same article, about 50% of those who are unvaccinated are moved enough by this increase in confidence that they “probably” or “definitely” will be vaccinated, and about 60% of parents are now willing to get their children vaccinated. Color me skeptical on that one. Talking with patients on the topic of vaccination, I have heard religious objections. I have had patients say that they are afraid that the vaccine since it is “Messenger RNA,” will alter their genetic makeup. Or have a negative impact on their fertility. Then there are those who believe that the vaccine will “magnetize” them or allow the government to track their movements. Does “FDA approval” relieve them of these objections?

Bottom Line. Just as I had finished reading this piece, I was scheduled to do one of my On Doctors’ MindsSM conversations to get an update for our hundreds of subscribers as to what is happening in office-based practices as a result of the pandemic. This doctor, a more senior primary care physician in a rural practice in Pennsylvania, offered that about 60% of his patients had been vaccinated and that he saw little likelihood of any more doing so. He has tried hard to get the balance to get vaccinated, but to no avail.

Survey research results versus the opinion of a physician with 50 years of experience under his belt. Which do we believe? Oh, and other factors, like major corporations, government agencies and academic institutions now feeling empowered to issue vaccine mandates given FDA approval might well have a significant impact on the outcome here.

What will Cominarty’s approval translate into in terms of new patients journeying out to get the “Fauci Ouchie?” 

Stay tuned!

The Ethics of Telemedicine

In my On Doctors’ MindsSM research that tracks the adaptations that office-based physicians have made to the COVID-19 pandemic, I have been fascinated to learn about how quickly clinicians were able to adapt to telemedicine, and some of the hurdles they encountered going up the learning curve involved in using this new technology.

But check this out. What you will see is a discussion of whether it is ethical for a physician to limit the treatment of unvaccinated patients to telemedicine visits. Survey results revealed that 69% of doctors thought this was ethical given the risk such patients pose to medical staff. A medical ethicist weighing in on the same topic agreed, but put in the caveat that if a patient’s condition requires personal contact for good treatment, e.g., in the management of a movement disorder, it was incumbent upon the practitioner to either allow personal visits or refer the patient to an HCP that would provide such service.

Bottom Line. Think about it. The COVID-19 pandemic brought with it, among many other things, a slew of new and important ethical questions with which healthcare providers must wrestle daily. As with so many aspects of the pandemic, I am thinking that the results of these wrestling matches will substantially modify thinking in the field of medical ethics for years to come.

If not forever!

Never Again!!!

Check this out. What you will see here are a lot of important observations and very meaningful words.  Like the assertion that COVID-19 caused the “moral crippling” of ICU nurses. Code for they could no longer do their jobs, the way they used to love to do their jobs, during the pandemic. Too many patients. Too little PPE.

And the irony of hospitals offering ICU nurses $5,000-$6,000 a week in compensation. In exchange for putting themselves and their families at risk. Feels almost like a perverse bribe, although Lord knows they earned every penny and more.

OH. And the balloons and music at the hospital doors. People yelling that they are heroes. But none of them is feeling like a hero. 

Bottom Line. And the greatest irony of all? The phrases toward the end of the piece. “We finally see the numbers go down. A sigh of relief.” This in piece written just over a month ago.

And the prayer. “Never again.” But here comes Wave 4. Can these nurses do this reprise? Their patients have to hope so!

God bless them one and all!

One Confused Physician

Check this out. What you will see is the rather amusing story of the day that Dr. Anthony Fleg, pictured above, unknowingly held a 20 minute “telehealth” visit with a patient who was sitting in an examination room in his clinic.  In a day comprised mostly of virtual visits, he had missed the intake note that said “Room 11.” A sign that things were starting to “open back up” in primary care. Also, a sign of just how confused the pandemic has gotten all of us, with those in the front lines of healthcare being particularly vulnerable.

Bottom Line. Sitting here as July transitions into August 2021, I wonder. I wonder what kind of confusion will be caused by the CDC once again flip-flopping on mask recommendations for the vaccinated. By Pfizer and the FDA trying to make sense of the need (?) for a booster shot. By doctors once again, without much guidance from anybody, trying to decide whether to close their offices and revert to telehealth. 

Every single doctor with whom I have held a conversation during the monthly iterations of my On Doctors’ MindsSM  project has told me that it has been confusion that has been the worst part of the pandemic. Lack of guidelines. Inconsistent guidelines. Unclear future. Unclear timing. You name it. 

As I listen to the news today, I think that we are unfortunately not done with this confusion!