On Vaccine Hesitancy: Making A Deposit in the Emotional Bank Account

President's Blog,

Despite working in solo family practice, I know I’m not alone in my efforts and frustrations with trying to vaccinate the unvaccinated against COVID. If one focuses on the picture painted by the news or social media, it is trench warfare with both sides dug in deeply. But the reality is more nuanced, and many patients find themselves stuck in no man’s land, not knowing who to trust. If we remain open and listen compassionately to the story behind each individual’s hesitation, there are still opportunities to make a difference. I will share one recent story that provided me with a little dose of positive emotional energy to remind me why I love primary care, and why I’ll continue to take on the challenges of this pandemic to keep my patients thriving and out of the hospital, one patient at a time.

My patient works as an aide at a long-term care facility. She had delayed getting vaccinated last year, then developed a bad COVID infection that we managed as an outpatient. Subsequently, she received 2 doses of vaccine with reluctance, but without adverse effects. Last week her employer instructed her to get a booster and asserted the SCOTUS decision upholding the vaccine mandate. “I don’t want to put anything else into my body” she protested, arguing there was no guarantee that she wouldn’t get COVID again. She pleaded her case for antibody testing instead and asked for a medical exemption from the booster.

Physicians deal every day with patients who choose not to follow professional advice – or do so selectively for a myriad of reasons. We routinely expect these behaviors and factor it into the way we deliver our message and advice, rarely taking it personally as the risks are generally limited to the individual. Consider the patient who chooses a nutritional supplement over an FDA approved medication or someone with heart disease who continues to smoke cigarettes.

Thus, no one is surprised that the COVID vaccine has failed to be universally embraced. However, this situation feels different because the ramifications are different. We are all suffering harm as a result of these individual choices not to vaccinate. The downstream effects of the strain of caring for so many patients with a largely vaccine-preventable degree of critical illness are vast.

Behind the hesitancy, each patient has a story. However, empathy is difficult when the stories themselves can be confusing, contradictory, or just false – particularly when cognitive distortions or conspiracy theories are involved. Both the storyteller and the listener often experience the same strong emotional response – doubt, uncertainty, fear, longing, fatigue, anger – but for different reasons. So how do we return to the middle ground?

Unlike any pro-vaccination campaign, news stories, or legal mandate, physicians have the opportunity and skills to engage patients directly in compassionate listening and without judgment. If we can keep our emotions in check for just a few minutes, we stand a better chance of making a positive impact on that individual one-on-one than something pushed out to a broad audience but social media algorithms. We may be the only articulate counter opinion that they hear or trust.

My patient’s request for an exemption triggered an immediate visceral reaction in me. But one benefit of interacting by secure messaging is having time to release the pressure valve before composing a response. A few messages explored the common ground, without drawing a hard line, and dissected out the issues at hand to validate and understand her conflicting emotions. A forced mandate felt wrong, and she feared that she wouldn’t have a job if she didn’t comply. But her medical conditions put her at very high risk if she contracted COVID again, and she cared deeply about the health of her patients. Furthermore, her co-workers would bear the additional burden of her decision if she got sick or had to quarantine.

Ultimately, she decided to get the booster for the benefit of her own health, and that of the at-risk population she works with. Understanding that she had made her own decision, she felt liberated to be as angry as she liked about being told what to do by her employer and the government. She followed it up with a comment that she “believe[s] in me and know[s] I would not steer her wrong.”

So in the end, she gets a COVID booster shot, and I get an emotional booster shot. A conversation that began with me feeling riled up over vaccine refusal, ended with me feeling grateful for the opportunity to make a difference and maintain an open, trusting relationship with my patient.

To my colleagues in the ER and the hospitals, those suffering the most from the impact of the unvaccinated, please know that we in primary care will continue to do our best to ease your burden. Each hesitant patient who gets vaccinated is one less risk to contend with.

Though some days feel like a losing battle, it’s important to recognize and fully appreciate that each positive “conversion” can stoke the energy to keep at it. So carry on and share your own stories with each other. We need to hear that we are making a difference, even if it is “just” one patient at a time. Each is a deposit into your emotional bank account that reminds us why we do this thing called doctoring.

Dr. Eric Kropp
NHMS President