A lot has been said about hesitancy among people deciding whether to get one of the three available COVID-19 vaccines in the U.S. But less is said about the hesitancy clinicians feel about speaking to their patients about getting one of those vaccines. As with masking, business and school closures, and other public health measures, the vaccination effort has been entwined with political divisions that can spark intense emotions and reactions.
Much of the talk around having COVID-19 vaccination conversations with patients relates to primary care physicians and clinicians who have longstanding relationships with their patients, and whom, in theory, their patients trust. An effort at Boston Medical Center (BMC) and other hospitals and health systems throughout the world is aiming to have every touchpoint with a clinician be an opportunity to have that vaccine conversation with unvaccinated patients. That would include specialists who may not have had a longstanding a relationship with that patient.
But in circumstances where trusting your physician is essential for making literal life-or-death medical decisions, some physicians feel concerned that raising a heated COVID-19 vaccine conversation could hurt a relationship.
What causes hesitance to have a COVID-19 vaccine conversation with patients?
Teviah Sachs, MD, MPH, chief of the section of Surgical Oncology at BMC, was recently in that position. In the video above and in conversation with HealthCity, he admits to how challenging it feels in the context of a clinic appointment to advocate for COVID-19 vaccines with unvaccinated patients. First, there's limited time with a patient and, in an appointment specifically to discuss surgical options for diagnosing and treating cancer, that time is essential. Second, there's the issue of trust.
"You may be worried that it might harm your relationship with your patient," Sachs says in the video, speaking to other clinicians who have concerns about raising the vaccine conversation. "It might make it harder for you to treat them for the problem for which they are presenting."
When one of Sachs' patients he had been treating for years showed up to their appointment, and BMC's medical record system alerted him that she was unvaccinated against COVID-19, Sachs says he was hesitant to address it at first. Still, he recalled an internal video that was shared among staff at BMC, giving tips for how to speak with your patients about COVID-19 vaccination.
Watch the 'Engaging with patients about the COVID-19 vaccination' video:
In the video, BMC experts Thea James, MD, vice president of Mission; Cassandra Pierre, MD, MPH associate hospital epidemiologist; and Sheila Chapman, MD, a primary care physician discuss how these conversations are crucial for equitable vaccine distribution and meeting patients were they are with open, empathetic dialogue.
Ultimately, Sachs overcame his hesitancy and used that advice to open an honest conversation with his patient about her vaccine concerns. And in that conversation, Sachs says, his patient raised many worries that the video addressed.
"She told me very clearly and plainly what she was worried about with the vaccine," Sachs says.
According to BMC experts, common concerns center on fears about long-term effects, the speed of the vaccine development, and generational trauma for people of color whose ancestors were abused by medical research (in such events as the U.S. Public Health Service Syphilis Study at Tuskegee and with Henrietta Lacks).
Sachs and his patient, as well as her daughter who was escorting her to the appointment, had a conversation addressing her concerns, where Sachs was able to share his own concerns about how COVID-19 infection would affect her specifically.
"We're all very busy, but our patients especially are vulnerable. And we owe it to them to really make this a priority," Sachs says.
Ultimately, both his patient and her daughter decided to get the first dose of the COVID-19 vaccine that day. It was confirmed to Sachs via his patient's medical record.
Sachs now, despite his own initial hesitancy, advocates for clinicians to speak with patients about their specific vaccination concerns.
"As a provider, we not only have to concern ourselves with the problem for which our patients are presenting but also be advocates for preventative medicine," Sachs says. "And one of the most important things we can do for our patients these days is to educate them and hopefully help them obtain the COVID-19 vaccine."