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“The starting point is to do our best to approach discussing COVID and vaccination with the appropriate type of empathy and understanding.
To understand that our patients don’t have access to the same level of data and research that we do, and even if they did, they might not understand it. To understand, they likely have fears underlying their reticence.
Understand you may not ever reach them, or you may need to back off for a short time. This can all be done without acknowledging their conspiracy theory or misleading talking point from 24-hour cable news is a legitimate point of view.
While admittedly anecdotal, I’ve reached more anti-vaxxers starting with empathy and understanding than with a ‘that’s the way it is, that’s what the data shows’ mentality. Even if I don’t reach them, I’m a lot less stressed. Last but not least, take care of yourselves and each other.”
Kenneth Szwak is a physician assistant.
He shares his story and discusses his KevinMD article, “A milligram of understanding for anti-vaxxers.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Kenneth Szwak. He is a physician assistant, and he wrote the KevinMD article “A milligram of understanding for anti-vaxxers.” Kenneth, welcome to the show.
Kenneth Szwak: Thank you much.
Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?
Kenneth Szwak: I’d be glad to. Really, it’s kind of one of happenstance and serendipity, as I would say. If you were to travel back in time to 18-year-old me and tell him what I’d be doing today, he would shake his head and say, “You’re crazy. There’s no way I’m doing that.” Basically, it kind of happened. I didn’t even plan on going, or I don’t even think my family planned on me going, to college. But I went to college, and just kind of gradually over time, I started doing EMS while I was in college.
I flipped over into a pre-nursing degree, then I started working in the ERs as an ER technician. I saw the doctors there, and I thought, “You know, I could do what they’re doing.” I flipped over into a pre-med curriculum. At the time, they told me about what PA school was, and at that time, in the early ’90s, there weren’t many PAs in New Jersey. So from my standpoint, it was still kind of a very new thing.
After graduating with my undergrad, I did pharmaceutical research for a few years, and then, when I knew I was ready, I wanted to go back into patient care again. PA school was just the better fit for me. Since graduating, I’ve been mostly in emergency medicine. I’ve done a little bit in other areas: a little primary care, a little internal medicine, a little critical care and pulmonary. But it’s mainly been emergency medicine. I got out of the hospital briefly; for the past three years I did a little urgent care. But as of recently, I actually just returned to emergency medicine in a travel capacity.
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Kevin Pho: So you said that when you first started going to PA school, there weren’t that many, and that was some time ago. Comment on the evolution of the physician assistant. What’s the status of the physician assistant now, in 2022?
Kenneth Szwak: It’s far more widespread. And just to clarify, when I first heard about the PA profession, there weren’t that many. By the time I got into the school, it was definitely much more prominent in my area, and I’ve just seen it grow over the years, to the point where, I want to say Forbes, or what are the magazines that do the top 10 growing fields in the United States? Physician assistant is way up there. It’s amazing to me, over the past 20, 25 years, how much it’s grown.
Kevin Pho: So walk us through a typical day, some of the things that you see currently in your travel capacity in emergency medicine.
Kenneth Szwak: You know, in the area I’m at right now, and with the weather we’ve been having, it’s been a lot of falls from trauma. So a lot of dislocated shoulders, a lot of fracture dislocations that need to be reduced. That’s what I’ve seen a lot of in the past month. And of course, COVID is still there as well. That’s still making up a lot of things that we’re seeing as well.
Kevin Pho: All right, so let’s talk about the KevinMD article that you wrote. It was written back in December. It’s titled “A milligram of understanding for anti-vaxxers.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Kenneth Szwak: Yeah. I mean, the basic premise, if I were to try to summarize it, would be that I think that as providers, and I’m sure there are going to be some who kind of raise their eyebrows when I make this statement, I don’t think we do enough to try and connect with the people who are against vaccines, or even on the cusp of getting the vaccine for COVID.
Part of that came from listening to a lot of other podcasts, not yours per se, but a lot of other podcasts that are either medical or scientific in nature. I noticed that there were a lot of people, a lot of providers, a lot of people who found them, who claimed to be scientific-minded, who really carry themselves in a very superior way, to the point where they would literally at times call people stupid. And you’re never going to make progress if that’s how you’re addressing people, even if you’re not addressing people to their face, even if you’re talking about them when they’re not there. I don’t think you’re ever going to make a connection, or we’re ever going to make progress in getting more people to see what the evidence really shows regarding vaccines, if we’re carrying this air of superiority, if we’re using any type of put-down.
Kevin Pho: So give us a sense of people who are hesitant to receive the vaccines in your travels in the emergency department, urgent care, or primary care. When you see someone who’s hesitant, or has questions, or flat out doesn’t want to receive the COVID vaccine, tell me, what’s your approach in terms of how to connect with them?
Kenneth Szwak: My approach is really to try and understand their fear, because I really believe that in all cases, there’s fear behind it, whether it’s fear of something as simple as they’re scared to get a needle, or they’re scared of, and again, I don’t mean this as a put-down, trying to understand the data, and maybe their fear of their lack of understanding, or their lack of ability to understand.
Because, yeah, let’s face it, even people who go into medicine, go into science, we learn a way to take apart research and to critique it, to know what’s good research versus bad research. If you’re an everyday person trying to really read stuff like that, that’s got to be overwhelming. So there’s got to be a fear on that end. And certainly there are people who fear and have a mistrust of the government being involved in this, when it comes to mandates. So to me, there’s always some level of fear, and I try to understand that.
Kevin Pho: And in general, when you try to connect with them, tell us a success story. Has there been a case where someone initially was hesitant to receive the vaccine, and you successfully connected with them, and then they changed their mind? Tell us a success story.
Kenneth Szwak: I think the success stories that I’ve seen kind of have a common thread, and that is, I try not to ask the question about vaccines from a viewpoint of, you know, I’m very pro-vaccine. I try to simply enter into the conversation just asking if they have any questions about the facts, as opposed to coming across and saying, “Why aren’t you vaccinated?” or “How come you haven’t gotten the vaccine yet?” That comes off as very challenging and very imposing to a lot of people. Even if that’s not your intent, a lot of people will take it that way.
So I try and approach it from, “What questions do you have about it that I can answer for you?” And I find that if I approach it from that point of view, and I’ve seen it happen, I have answered their questions, and then that light bulb kind of goes off, and you can see it, you can see that light bulb go off. I’ve gotten a lot more people to either consider or flat out get the vaccine from approaching it that way, as opposed to coming from a more challenging standpoint of why aren’t they getting it.
Kevin Pho: So I think an underlying message of your piece is a reflection of a broader society. We’re all tribal, right? It’s either for or against, and everything is so divisive and polarized, and I think that goes not only with vaccines but pretty much any topic that you read in the newspaper or read on Facebook and social media. Now, from a broader messaging standpoint, you talk about connecting with people who don’t necessarily agree with you. You talk about not talking down to them. Now, what are some ways that we can do that on social media, podcasts, or mainstream media? What are some ways that we can connect with people who don’t necessarily share our worldview?
Kenneth Szwak: I may give away something when I make this next statement, but I agree with them. I think we need to check our biases and our personal feelings at the door. And that’s, I think it’s really because we all have bias, we all have personal feelings, but if we let them run what we’re doing, whether it be a podcast or a patient interaction face-to-face, I think that’s what kind of creates the conflict.
We need to realize, and I also need to realize, that at the end of the day, no matter if we pose the best argument in the most respectful way, a patient’s still going to do what they’re going to do. And this is regardless of whether we’re talking about the COVID vaccine or smoking cessation. We have to let go and understand that our job is to present to them what the evidence shows, inform them, and make sure that they are informed. At the end of the day, they’re still going to make their own decision, and that’s not in our control. And if we start thinking it is within our control, and that’s kind of one of those biases that I’m talking about, if we start thinking it is in our control, that we can tell patients what to do, then that’s just going to lead to disaster, I think.
Kevin Pho: So what are some techniques that you use to check your bias at the door? Because I think that’s very good advice. We have to be less judgmental of people who don’t necessarily agree with us, and I think that’s really one of the key ways that we can connect with them. So what are some ways that we could check our biases? Is it just simply taking a deep breath? What are some ways that you do that?
Kenneth Szwak: You know, it’s funny you say that. I do the deep breath a lot, particularly because sometimes you’re still broadsided by it. I remember one particular instance where I simply asked the patient if they had been, because it wasn’t in the record where I could see it, and I just simply asked, I said, “Have you gotten the vaccine?” And before I got to the end of “vaccine,” the patient just exploded on me. He’s like, “No, I’m not getting the vaccine. You can’t talk me into getting the vaccine.”
It was one of those things where I just had to take that deep breath and say, “OK, what’s going on here?” because something triggered this guy. And yeah, I took the deep breaths, and I kind of backed up and said, “Listen, I’m not asking you to get the vaccine. I’m just asking if you’ve had it, yes or no.” And I think sometimes it’s just a matter of calming yourself down, taking that deep breath, and sometimes just starting from scratch.
Kevin Pho: We’re talking to Kenneth Szwak. He’s a physician assistant, and he wrote the KevinMD article “A milligram of understanding for anti-vaxxers.” Kenneth, what are some of your take-home messages that you want to leave with the KevinMD audience?
Kenneth Szwak: I think at the end of the day, we have to check our bias and our personal feelings at the door. I think it really just comes down to that. If we walk into a situation with a full head of steam, of, “I know the evidence, I’m right,” and we do, I mean, obviously we read the evidence, we read the articles; it’s not a question of whether or not we do understand it. But if we approach a patient interaction with that authority, that “I’m the end-all, be-all of this, and they need to listen to me,” then it’s going to be a rough road. It’s just going to be a rough road.
We need to just understand that patients have fears. Sometimes they’re justified. Certainly, for a patient to ask, to be concerned about the side-effect profile, that’s a reasonable question. More patients should be asking about that, no matter what we’re prescribing them, whether we’re recommending the COVID vaccine or prescribing them an antihypertensive. Patients should be asking questions about side effects, and we shouldn’t be getting upset about that. So, like I said, at the end of the day, we need to kind of come down, I guess, for lack of a better word, a little bit more to their level, and understand that they have fears that they might not be able to verbalize themselves. Sometimes that’s part of what we have to dig into and figure out.
Kevin Pho: Kenneth, thank you so much for sharing your time and insight. Thank you for being on the show.
Kenneth Szwak: Thank you for having me.
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