Category: Physician Mindset

“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!

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! 

Practicing at the “Top of the License”

Check this out. We have done versions of this riff before. Doctors complaining that while NPs and PAs are exhorted to practice at the “top of their licenses,” MDs are increasingly relegated to grunt work. But this time around, the complainant is an anesthesiologist, who wonders why in Europe, anesthesiologists always have an assistant in the OR, while in the US it’s a solo act. 

SO. Here’s the part that confuses me about this. Unless I am missing a point, the establishment of the role of the certified registered nurse anesthetist (CRNA), with multiples thereof working under the supervision of an anesthesiologist, is one of the best examples of the leveraging of physician time with which I am familiar. Check in at our local surgi-center for a procedure, and you get a quick interview with the MD. Into the OR you go, and the CRNA is the one who is hitting you with propofol. Makes sense. Well leveraged. 

Bottom Line. In years to come, it will be fascinating to continue to watch the shifting of roles amongst physicians and other medical professionals. Hopefully, the focus will remain on efficiency and safety of patient care, and politics will be left by the wayside!

A Time for Doctors to Shine???

Check this out. What you will see is a physician author describing physicians as going through Kubler-Ross’s five stages of grief in terms of their professional autonomy and compensation. Over the last couple of decades, doctors have increasingly been forced to cede their power, and much of their incomes, to stronger forces. Insurance companies, medical systems, etc. Early on, we saw doctors in the first stage of grief. Denial. Doctors denied that their lives were being tampered with, and they stayed silent. Mentions of physician “unions” were rebuffed. 

Over subsequent years, the doctors predictably marched through the other stages of grief. So now they are where they are. Interestingly, as COVID-19 looked like it was passing off into history, doctors believed that this would be an ideal time for them to recapture their pre-grief former lives. Not so fast! Many of our citizens are facing difficult financial times as a result of the pandemic. Small businesses are struggling to stay open. AND. Many Americans are mindful that among developed countries, the US has the least cost-effective healthcare system on earth. Not a great time for doctors to be asking for more money and more autonomy.

Bottom Line. SO. Dr. Pearl is suggesting that American physicians move on to the last stage of grief. Acceptance.  No, not acceptance of the fact that our healthcare, and doctors’ lives, will continue to get worse and that there is nothing to be done about that.  Nope. Acceptance of the realization of what is broken, e.g., an uncoordinated fee for service system. And making the commitment to fix the problems. 

Then, and only then, will physicians and patients be able to stop grieving!

Industrialized Medicine

Check this out. What you will see is a psychiatrist, who specializes in helping physicians and their organizations deal with “complex personal challenges,” asking his colleagues a question. Are they “healers” or are they “widgets.” According to Dr. Adelman, the trend over the last 50 years toward “industrialized medicine,” where doctors’ workflows are controlled by corporations rather than by their own wills, has caused there to be so much “coming at them” that they are like Ethel and Lucy in the chocolate factory. They just can’t keep up. They become unable to do “their best work.”

A powerful quote from Adelman’s post:

Malaise sets in when you realize that you have become an almost inanimate object.  This is ‘physician burnout,’ which has been conceptualized by some as a form of moral injury visited upon us by industrialized medicine.

Bottom Line. The move away from being a healer and toward being a widget seems inexorable. This is not likely to get better in coming years.

My question? Then what will “worse” look like in years to come???

Fewer Physician Visits By PSRs Post-Pandemic?

As you will see in these survey results from FirstWord, that is the desired scenario for about half of the 100 doctors they polled. Throughout the six months of reporting on the results of my On Doctors’ MindsSM conversations, that about lines up with what I have been finding. As we predicted back in November of 2020, many doctors are looking forward hopefully for a return of the “old normal.” BUT. About half of all physicians we have talked to, and especially many specialists, have learned over the course of the pandemic to “do without” PSRs, readily getting  the answers and information they need in their practices from other sources. 

While you are looking at these results, check out the data concerning virtual details. Here, 57% of doctors reported that they find them to be equally or more “effective” than personal PSR visits. BUT. In my conversations with physicians, the majority of doctors are avoiding these virtual visits like the plague (Sorry!) due to difficulties in scheduling and the extra time required. Translated, perhaps the virtual details that are happening are “effective,” but most of my discussants, and I believe most physicians more generally, are not letting them happen.

Bottom Line. Throughout our study of the effects of the pandemic on office-based physicians, we have been telling our pharmaceutical clients that they had best be prepared to increase their physician micromarketing sophistication as the pandemic winds down. Doctors are differing widely in their preferred mode of communicating with pharmaceutical companies. One size definitely doesn’t fit all here, and we need to be ready to respond to these differing physician preferences. 

It Is Wrong For Doctors To Retire “Early?”

The gentleman pictured above is Dr. Jimmy Turner, the self-proclaimed “Physician Philosopher”. In this post, he sets out to debunk the title shown above. In doing so, he argues that a physician’s early retirement does not render the slot he occupied in medical school a waste. How many years should a doctor be required to practice in order to make his education worthwhile? 10? 20? Until he dies? Good question!

He also defuses the concept of early retirement contributing to the physician shortage. Here, he argues that too few doctors entering the field, rather than too many doctors leaving medicine, is the actual cause of the doctor shortage. He’s probably right again!

Of course, Dr. Turner has an axe to grind here. He coaches physicians on the principles of FIRE, Financial Independence and Retiring Early. 

As I pondered this piece, I thought of the work I do as a Board member at Volunteers In Medicine on Hilton Head Island, SC. We have 10,000 patients who would otherwise be medically underserved. And what lets us care for all of these patients with only a minimal budget? Volunteers. RETIRED volunteer physicians, nurses, dentists, pharmacists, etc., all anxious to continue to put their clinical skills to good use, especially now that they don’t have to worry about running a practice as a business. Many in their 70’s, retired for years, but still going strong.  

Bottom Line. So, is it really wrong for a doctor not to work full time practicing medicine until she dies, worried the whole time about finances and burning out? 

I am going with a big “No” on that one! How about you???

The Rise And Fall Of Doctor Google

The Rise And Fall Of Doctor Google

Check this out. What you will see is a complicated interplay of public perceptions of physicians and the doctors’ own self perceptions. Said what?

Here’s the deal. Prior to the pandemic, Americans were increasingly likely to trust medical advice found on Google and in the social media, and decreasingly likely to trust physicians. Scroll forward. COVID has brought a return of the perception that “the Doctor knows best.” Only problem is, now that they have been placed back on their pedestals, doctors are more than well aware of their limitations in preventing mortality and morbidity caused by the coronavirus. AND. They still have to deal with the administrative claptrap that was burning them out prior to the pandemic. AND. They are wrestling with new factors like telemedicine which were thrust upon them by the pandemic.

Bottom Line. It’s not an easy time to be a physician. Was it ever?

The “Difficult” Patient

A simple thought for the day. Check this out. What you will see is a brief but fascinating little piece. The point? With 15-60% of patients being considered by their physicians to be “difficult,” the underlying problem just might not be one of psychiatric pathology in the patient. Maybe the problem needs to be reconceived as resulting from a damaged interaction between the patient and the “health care delivery” she has encountered.

Bottom Line. It always amazes me how often “reconceiving” a problem can be a powerful first step towards its resolution.  

Doctors Don’t “Communicate” About Medications

Check this out. What you will see is a simple but important thought. Our old friend, The Country Doctor, suggesting that while businesses spend a disproportionately large percentage of their time and effort focused on how to sell something rather than on how to produce it, physicians take the opposite approach. Especially given the increasingly tight limitations on their time, doctors simply cut to the chase, tersely telling patients what medications they need to take and how, and failing to “sell” the drugs and their benefits with anywhere near the same level of intensity that the drugs had been sold to them.  

Bottom Line. So what? So plenty! Consider the impact of all of this on patient adherence. And, perforce, on the doctor-patient relationship.  

Maybe we, as an industry, need to help doctors to become better salespeople. I am thinking that this could result in a triple win. For the doctor, for the patient, and for us!