Your patient has acute SARS-CoV-2 infection.
They are unvaccinated.
What’s the best way to talk to them about their vaccination status?
1/
They are unvaccinated.
What’s the best way to talk to them about their vaccination status?
1/
In most patients with intact immune systems, vaccinations against SARS-CoV-2 work to reduce incidence and severity of COVID-19.
However, to date, approximately 40% of eligible Americans are unvaccinated.
/2
However, to date, approximately 40% of eligible Americans are unvaccinated.
/2
As the delta variant spreads, and hospitals fill, these morally challenging encounters are on the rise.
And we are tired.
/3
And we are tired.
https://twitter.com/freckledpedidoc/status/1389621343524696068?s=20@MarkHertling
/3
With battle fatigue, frustration, and all flavors of burnout, empathy goes right out the window.
/4 @ETSshow #MedLasso
/4 @ETSshow #MedLasso
Is physician empathy important to you on a personal level?
/5
/5
Empathy is an important characteristic of our professional identity. Sometimes we are great, deep, method actors in conveying empathy. Sometimes we can’t dig deep and have to just be a “surface actor.”
pubmed.ncbi.nlm.nih.gov/15741532/
/6
pubmed.ncbi.nlm.nih.gov/15741532/
/6
So, whether you're able to dig deep or must fake it 'till you make it, conveying empathy to this patient is important.
Empathy and humanism go together.
/7
Empathy and humanism go together.
/7
#Empathy means walking in someone else’s shoes. 👞👟👠👢
The “golden rule” in #humanism is to treat other people as you’d want to be treated in their situation. ➡️⬅️
/8
The “golden rule” in #humanism is to treat other people as you’d want to be treated in their situation. ➡️⬅️
/8
In the world of #Healthcare communication, there are many approaches for clinicians to talk with patients.
Think: a more technical approach (“biomedical”) 🔬 or a more relationship-centered approach (“patient-centered”)☀️.
/9
Think: a more technical approach (“biomedical”) 🔬 or a more relationship-centered approach (“patient-centered”)☀️.
/9
Out of context, the most empathic or humanistic of the approaches is called “Patient-centered communication (#PCC).”
/10
/10
PCC includes four communication domains:
(1) the patient’s perspective
(2) the psychosocial context
(3) shared understanding
(4) sharing power and responsibility
/11
(1) the patient’s perspective
(2) the psychosocial context
(3) shared understanding
(4) sharing power and responsibility
/11
Our patient, who is in a vulnerable situation, likely prefers a patient-centered approach. So, let’s reframe our initial question:
What’s a patient-centered approach to talking about their vaccination status?
/12
What’s a patient-centered approach to talking about their vaccination status?
/12
Table 1 presents a list of items that a study used to measure a physician’s informativeness (I), supportiveness (S), and partnership-building (P). These items were summed to create a single measure of patient-centered communication.
pubmed.ncbi.nlm.nih.gov/17462801/
/13
pubmed.ncbi.nlm.nih.gov/17462801/
/13
So, let’s:
✅ Be informative
✅ Be supportive
✅ Promote partnership
📖 Read on for some examples!
/14
✅ Be informative
✅ Be supportive
✅ Promote partnership
📖 Read on for some examples!
/14
INFORM.
“You have COVID-19, which is a viral infection. It is [mild/moderate/severe]. Vaccines for COVID-19 generally work well.”
Pause.
If pt has ?'s or false concerns re: vaccination, continue to inform, w/o over-teaching, & w/professional discourse.
/15
“You have COVID-19, which is a viral infection. It is [mild/moderate/severe]. Vaccines for COVID-19 generally work well.”
Pause.
If pt has ?'s or false concerns re: vaccination, continue to inform, w/o over-teaching, & w/professional discourse.
/15
SUPPORT.
“Did you receive the vaccine?”
Patient: “No.”
“To help me better help you, can you tell me why you did not?”
/16
“Did you receive the vaccine?”
Patient: “No.”
“To help me better help you, can you tell me why you did not?”
/16
Listen. The patient will give some sort of answer to your question.
Your first response to an often vulnerable or contentious reason for not getting the vaccine should convey empathy.
/17
Your first response to an often vulnerable or contentious reason for not getting the vaccine should convey empathy.
/17
Which of these empathic statements, do you want to try on for size?
A. “Many people have felt the way you do about vaccines.”
B. “I wish you had had the vaccine, but that’s in the past now.”
C. “Well, I’m here for you.”
D. Other
/18
A. “Many people have felt the way you do about vaccines.”
B. “I wish you had had the vaccine, but that’s in the past now.”
C. “Well, I’m here for you.”
D. Other
/18
PROMOTE PARTNERSHIP.
“Certainly we will focus on your current infection. But looking ahead, current recommendations are for patients to receive the vaccine x weeks after their infection. I encourage you to do so.”
/19
“Certainly we will focus on your current infection. But looking ahead, current recommendations are for patients to receive the vaccine x weeks after their infection. I encourage you to do so.”
/19
If still hesitant, or anti-vax, try:
“While we disagree about vaccination, I am your physician and will take care of you through this illness.”
/20
“While we disagree about vaccination, I am your physician and will take care of you through this illness.”
/20
SUMMARY:
Your patient has COVID-19. They are unvaccinated.
Try this approach to talking about their unvaccinated status:
Inform. 💡
Support. 🏋️
Promote partnership. 🤜🤛
The #PCC approach will get us much further in a discussion than “Told you so.”
/21
Your patient has COVID-19. They are unvaccinated.
Try this approach to talking about their unvaccinated status:
Inform. 💡
Support. 🏋️
Promote partnership. 🤜🤛
The #PCC approach will get us much further in a discussion than “Told you so.”
/21
cc: @tony_breu @AdamRodmanMD @vschaye @gopiastik @andrewolsonmd @DxRxEdu @gradydoctor @emily_fri @MS_Martinez_MD @gretchemaben @MKIttlesonMD @michellebr00ks @beridgeway @medpedshosp @ArunabMehta @Mud_Fud @Neil_Mehta @craigniel13 @MegMcGerv @SamirShahMD @Bob_Wachter @ACHonline
Adding this here since it’s a nice resource to #inform. Thanks @evebmd 💖
https://twitter.com/evebmd/status/1430846819177746432
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