I was recently scrolling through my Facebook newsfeed when I came upon a long message chain started by one of my friends, an older woman from my hometown in New Jersey. She had seen a discussion given by a drug representative who was promoting administering Gardasil to early adolescents for the prevention of cervical cancer, and my friend wanted to know how other parents felt about allowing their children to be given the vaccine.
The discussion that followed was remarkable to me for a number of reasons. I knew that there was a lot of public suspicion surrounding the HPV vaccine, much of it fueled by fear of negative side effects and distrust of big pharma. What I didn’t realize was how often this distrust extended to include the pediatricians who are currently recommending the vaccine for children ages 11 to 12 years old, with the hope of preventing them or their future partners from contracting cervical cancer. Many of the men and women from my hometown stated that they would not be following their pediatrician’s recommendation to vaccinate their children, some even going as far as to call their doctors “drug pushers.”
As a second year medical student, I found this upsetting. It is embarrassing to admit, but the distrust of these strangers for the profession that I am about to enter struck a nerve, and reading their comments left me hurt. Every currently practicing physician in the United States has gone through a rigorous training program that includes four years of undergraduate education, four years of medical school, and several additional years of residency. At each step along the way, there are board examinations designed to ensure that a high level of competency is achieved and maintained. As someone in the middle of this whole process, I can tell you that it is exhausting.
From my observations, the two main things that sustain medical students during the isolated years of their preclinical training are caffeine and idealism. Following the deep and abiding debt that we all owe to Starbucks, the most important thing that keeps us going is the idea that the things we are studying matter, that with the knowledge we are forcibly cramming into our brains we are some day going to be able to change the world for the better, one patient at a time. We imagine entering into meaningful partnerships with our future patients and working together towards better health outcomes for all. The idea, then, that some patients might not trust us implicitly, might question our motives and not believe that we have their best interests at heart, feels like a betrayal on their end. Look at all of this hard work we are putting in, for you! And now you question our professional advice? How ungrateful!
This is, of course, an incredibly unfair knee-jerk reaction. The fact of the matter is that the medical profession does not always get it right, and the natural and fair consequence of medical error is patient distrust. The men and women discussing the HPV vaccine referenced some of the known negative side effects of Gardasil. One woman had seen a girl faint at the pediatrician’s office after receiving the vaccine. Others had heard of children having severe allergic reactions to the vaccine. It is understandable that some of these parents were not rushing to line up and give their children these vaccines.
The problem is not that patients are questioning medical advice from their physicians. We live in a time when patients have more access to medical information than ever before; a quick Google search can give anyone access to newspaper articles, research studies, and medical articles on any health care topic. Provided that they are reading reliable sources, patients can become incredibly well-educated on their own medical conditions, and it is not uncommon for patients to come into clinic with several research studies in hand and definite opinions on how their health care should be managed. And this is excellent. It allows patients to be active partners and directors of their own health care, and to work more closely with their physicians towards the outcomes they desire.
It is not a bad thing when patients question the advice of their physicians; however, it is a bad thing when patients question the motives of their physicians. Every physician that I have interacted with throughout the course of my training has wanted the best for his or her patients. Physicians are fallible, and it is more than fair for patients to questions their treatment choices. However, if patients are questioning whether or not their doctor is giving treatment recommendations with their best interests in mind, both parties need to take a long hard look to find where the relationship went wrong. I do not understand the distrustful tone with which some of the parents who were against vaccination spoke about their pediatricians, and can only assume that it came from a failure of communication for which both parties are to blame.
In the Facebook message chain surrounding the HPV vaccine, the respondents could be divided into two groups: those who were interested in getting the vaccine for their children, and those who were not. They could also be divided into two separate sets of groups, though, and these did not necessarily overlap with the first set of groups. These two groups were those who had clearly read up on the Gardasil vaccine, understood its benefits and risks, and wanted to make an informed decision when it came to their children’s health care- and those who seemed to know very little about the vaccine but were willing to offer a strong opinion on the matter. More simply put, these two groups were those who knew what they were talking about, and those who did not.
We should all strive to be members of the first group — those who know what they are talking about when it comes to health care. For physicians (and future physicians), this means completing a full course of medical education and striving to remain well-informed and current with our medical knowledge. For patients, this means reading up on the issues that matter to you and coming to appointments ready to have a conversation about your health care needs and desires. And finally, trust that your physician has your best interests at heart. If you don’t believe it, find a new physician. The patient-physician relationship is an incredibly important component of our health care system, and by fostering strong relationship based on clear communication, we will be far more likely to achieve the positive health care outcomes that we all desire.
Heather Flynn is a medical student.
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