As a primary care physician, I eagerly discuss the importance of routine vaccines with my patients. My patients bring varying beliefs and opinions about vaccines to our conversations. Some of my patients share my enthusiasm, and other patients share their questions or hesitations with me that we review in greater detail together. Still, other patients share with me worries and fears about vaccines that my counseling and reassurance can only infrequently overcome.
I certainly respect my patients’ choices in my practice; I chose primary care because I truly treasure the collaborative, longitudinal relationship that I can craft alongside my patients. Primary care has felt like home to me because I can offer partnership and non-judgmental understanding to my patients.
As a young physician, I have sometimes struggled to find balance between this commitment to allyship and the recommendations I have learned to offer through my own medical education and training. I have worried that more directive recommendations could usurp my non-dogmatic intentions. For example, I have worried that emphatically recommending to a patient the initiation of an evidence-based medication to reduce their risk of cardiovascular disease invalidates true fears or negative experiences they carry about Western pharmacologic interventions. However, in these difficult moments, I have learned that my levelled partnership with my patients does not solely exist in the space of nonjudgmental, nondirective understanding; rather, as a physician, my partnership with my patients in medicine exists in my own art of merging my objective understanding of my patients’ medical conditions with the unique realities of their lives.
In the realm of vaccines, however, my normal hesitations seem far muted. My patients share with me their fears of vaccines, and their fears stem from similarly valid experiences. Yet, I inwardly struggle to find the empathy that usually comes more easily to me, and I can feel within myself those twin twangs of frustration and annoyance that I wish never reared their heads in my patient encounters.
In reflection, I wonder about my frustration with the particular challenge of vaccine declination. Some situations in my clinical practice – the robust, middle-aged man with iron deficiency anemia who would not schedule his colonoscopy, or the woman with months of depression who abruptly discontinued her counseling appointments and her medications – heighten my frustrations because I can find, in my mind, the stories of other patients or loved ones of my own who have faced similar situations and made alternate and, importantly, life-changing choices. On the other hand, I do not carry a personal narrative of an adverse experience that I have directly lived due to non-vaccination. Instead, vaccine declination carries its own public charge, with the medical community at frequent odds with the anti-vaxxer’s world. My frustration, too, seems to burgeon through these roots of public health and community well-being.
In the United States, we are hopefully at the precipice of a COVID-19 vaccine, with an initial vaccine under the FDA’s emergency review. When approved, I trust that the vaccine will be safe, researched appropriately, and vetted thoroughly. When I receive an opportunity to become vaccinated, I will step forward. However, in the unique realm of this pandemic, the novelty of a COVID-19 vaccine sparks my own anxieties. We hear reports from vaccine trials of adverse events, and, despite my faith in the development and safety evaluations of the vaccine, I carry fears that sound reminiscent of the fears that my patients share with me when they hesitate with their annual influenza vaccine, or the new shingles vaccine, or a tetanus booster. I fear that I will feel unwell after vaccination, and I worry about the extremes of adverse reactions to the vaccine. I worry about efficacy. I have the fleeting thought – could I contract COVID-19 from the vaccine? – and vow to shake the facts of science back into my thinking and read about the pharmacology and biochemistry behind the most recently developed vaccines.
In my lifetime, I have never experienced these concerns about vaccines for myself. When I received my influenza vaccine this year, I glanced very momentarily at the obligatory information sheet about vaccine risks, and I then speedily consented to my receipt of the vaccine from the nurse. Before I receive a COVID-19 vaccine, I plan to read thoroughly about the vaccine in a way that would seemingly cast my rapid look at my influenza vaccine information sheet in a hasty or even careless light.
I share these reflections in the hope of gleaning learning from another aspect of this exceptional time. In this pandemic, unexpected and extremely unique challenges face the medical field, from ethical questions of resource allocation, to virtual medical care, to our patients’ psychosocial isolation and ourselves. Now, too, I personally face vaccine anxiety in a way that I never, before the onset of the COVID-19 pandemic, expected to encounter in my lifetime. Though I still endorse with enthusiasm the importance of vaccines for my individual patients and for the preservation of public well-being, I reflect on my vaccine-related anxieties and hope to use these worries to better understand my patients that may routinely decline vaccines for infectious diseases both beyond and including COVID-19. Perhaps then, my new experience of vaccine-related anxiety can better my counseling of these patients. As a worried COVID-19 vaccine candidate, how would I wish for my physician to receive and hold my concerns? As an anxious future recipient of a COVID-19 vaccine, how would I wish to receive guidance from my own medical provider? What language would help allay my fears, and what words would perhaps entrench my fears more deeply? And, critically, can I harness my own anxiety-driven preferences in order to engage my patients in more effective counseling regarding vaccines? Importantly too, in my counseling of these patients, I hope I can better tie my white coat’s recommendations with the drive for empathy that – though has waned in my vaccine declination conversations – underlies most purely my aspirations as a physician to and partner with my patients.
Cynthia Tsai is an internal medicine resident.
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