The conversation that takes place before the flu shot

In our practice, doctors have the option to administer influenza vaccines right in the exam room. The truth is, giving the flu shot only takes a couple of seconds. The syringes are pre-filled, so all you have to do is pop on a needle, swipe the patient’s upper arm with an alcohol pad, and jab.

It’s the conversation that precedes the flu shot that takes time.

Take yesterday. A very intelligent middle-aged woman came in for her annual physical. She’s got a graduate degree and works primarily with the elderly. Though virtually everyone over six months old is eligible for the influenza vaccine, an updated version of which is available in the U.S. every fall, it is especially recommended for people at particular risk of getting the flu, getting complications from the flu, or transmitting the flu to those most vulnerable: people over 65 and under five, those with diabetes, heart, lung, and immune diseases and other chronic conditions, health care workers, and those who have frequent contact with those at high risk. I explained to my patient that her job put her in the high risk group.

The conversation that ensued was similar to many I have every year around this time, and about which I wrote last year in this blog. The patient told me that she was leery of getting the flu shot after a bad experience she’d had with it many years ago. When I inquired about the “bad experience”–an allergic reaction?–she explained that she’d had more respiratory infections than usual the winter after she’d received the shot.

I barely had to mention that there’s nothing in the flu vaccine, which contains no live virus and has no way to cause (or prevent) colds, bronchitis, sinusitis and other common infections. My patient knew all this…intellectually. She still had, as many of my patients do, a bad feeling about the flu shot and its potential side effects.

A new report from the University of Minnesota may help allay these concerns, and raise new ones. The report, nicely summarized in this article, asserts that while the current flu vaccine is safe and should still be used, it’s not nearly as effective as it should be, especially in the elderly. It asserts that the effectiveness of the vaccine in the elderly may have been overestimated, in part, because older people who get the vaccine may be those who go to doctors and take better care of their health generally. The author of the report expresses concern that as long as we continue to be over-confident in the effectiveness of the current vaccine, researchers (and manufacturers) won’t be motivated to improve it.

The Minnesota report is provocative and will no doubt raise eyebrows at the Centers For Disease Control, which strongly endorses widespread administration of the flu vaccine.

So I’m still giving flu shots … and bracing for even longer conversations about it this year.

Suzanne Koven is an internal medicine physician who blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50

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  • Craig Bradley

    You miss one of the main tools I think makes sense for the mostly healthy middle-aged, and that is that getting the flu shot is one of the easiest ways to be truly altruistic. In reality, your patient probably won’t get all that sick if she gets the flu. But as a flu vector, she might spread to a few or to many and each of those in turn might spread until someone truly immunocompromised or elderly or neonatal ends up with an infection she could have stopped. And they die.

    In my view, healthy people don’t get the flu shot for themselves. They get it for the good of the community.

    We should encourage that behavior.

  • http://warmsocks.wordpress.com/ WarmSocks

    This year, the strain of flu circulating in my community is a variant, not what was anticipated. People who were vaccinated are still getting the flu – not a very good selling point.

    • ColdHands

      That’s always going to happen to some people, though. The vaccine never promises to cover all flu strains, just those considered to be most common or problematic.

  • w_km

    Point well made…I think only time will allay most patients’ concerns. Widespread use of the internet for general medical information has been around for about 10 years. The word will eventually spread to those who can read (or listen/trust their HCP) and these pre-shot conversations will shorten.