Refusing the flu shot: Respecting the patient’s right to choose

I’ve spent the past four weeks learning about primary care on my family medicine rotation. A significant portion of patient care in this setting is focused on health maintenance or disease prevention. Physicians can provide their patients with evidence-based recommendations for various screening tests and vaccinations, but it is ultimately up to the patient to decide what services he or she will receive.

According to the Centers for Disease Control and Prevention (CDC), the best way to prevent influenza, more affectionately called “the flu,” is to get vaccinated each year. During flu season, which extends from October to May, many primary care physicians offer their patients the flu shot as a routine part of their health maintenance.

Over the past month I’ve had a number of interesting conversations about the flu shot that have allowed me to evaluate my role as an educator. How do you assess patient understanding? How hard do you need to drive certain points? Will patients perceive you as bossy or overbearing?

I respect my patients’ right to choose, but sometimes I’m concerned that they make choices based on fiction rather fact. It’s been quite a challenge learning how to debunk misconceptions, without seeming too pushy.

This week I helped care for an elderly woman named “Ms. Jade.” She visited the office for a follow up visit to manage her hypercholesterolemia, or high cholesterol. After discussing her chronic condition, I took the opportunity to assess her health maintenance and check if she was up-to-date with all the assessments recommended for a woman of her age.

Ms. Jade was on track with everything from her annual vision screening to her colonoscopy. The only preventive health maintenance item she was missing was the flu shot. Her chart read “flu shot advised 2012, declined,” meaning that she was offered the flu shot last year and opted not to take it.

“I see you have not received a flu shot this year, Ms. Jade. Would you be interested in receiving this vaccine today?” I asked.

As soon as I mentioned the words “flu shot,” she became flustered and stated that she was never going to get it. Given the fact that she had received all of the other recommended vaccinations, I was surprised by her reaction. I proceeded to ask her why she wanted to decline the flu shot.

“Well, I’ve never gotten the flu in my entire life,” she explained. “I never even catch colds.”

I told Ms. Jade that most people don’t get the flu, but that if you happen to contract it, especially as an elderly person, it can be quite bad. The flu shot protects you because it helps your body develop antibodies to fight off an infection, if you got one.

Ms. Jade continued to shake her head and said, “My brother got the flu shot and then he got sick and died.”

I immediately understood that Ms. Jade was not concerned about her odds of catching the flu. She was afraid of the vaccine itself. In her mind, the vaccine killed her brother.

“Ms. Jade, I respect your right to refuse the vaccine. It is absolutely your choice, but I wouldn’t be doing my job if I allowed you to make decisions without all the facts at hand.”

I tried my best to explain to her that correlation does not imply causation — that just because her brother received a flu shot before he died, does not mean that it led to his demise.

“The viruses in the flu shot are dead, so you cannot catch the flu from the vaccination,” I said. “At worst, the side effects include soreness or aches at the injection site and a low grade fever.”

I asked her if that sounded reasonable. “Yes,” she replied, “but I still refuse to get the flu shot.”

Patients, are there instances where you feel like your physician is infringing on your right to choose your care? Is there a right way and a wrong way to communicate medical recommendations?

Physicians, did I adequately address my patient’s concerns? Did I fulfill my obligation to provide my patient with all the information she needed to make an informed decision?

Jennifer Adaeze Anyaegbunam is a medical student who blogs at her self-titled site, Jennifer Adaeze AnyaegbunamShe can be reached on Twitter @JenniferAdaeze.  This article originally appeared in The American Resident Project.

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