Vaccine access, acceptance, communication: What physicians encounter with patients

Health and Human Services Secretary Robert F. Kennedy, Jr., has received praise and criticism for his approach as one of the nation’s top health leaders.

Many physicians agree the United States needs a better strategy to counter the rising rates of chronic diseases that have a huge financial and human cost. It’s a foundational concept of Make America Healthy Again, the effort Kennedy is leading under the administration of President Donald J. Trump.

But medical groups have been outspoken against Kennedy’s statements about vaccines as a potential harm, not a help, to the health of children and adults.

Vaccine skepticism is affecting patient decisions and physician practice at the macro level, and in the examination room, said Jason M. Goldman, MD, MACP, president of the American College of Physicians (ACP). Dedicated to internal medicine, ACP remains the largest medical specialty organization in the United States with 162,000 members. ACP has advocated for vaccination, has published resources devoted to quashing medical misinformation, and has called for Kennedy’s removal.

This transcript has been edited lightly for length and content.

Medical Economics: Regarding the practical effect of availability, have you come across anything yet that is indicating that the confusion and the debate is actually leading to lesser amounts of vaccine going out to doctors’ offices and pharmacies?

Jason M. Goldman, MD, MACP: It's twofold. One, there's the delivery of vaccines, and two, there's the uptake, so the access to care versus the patients accepting it. That's when you get into the resources, as well as the acceptability of a public health intervention. And I'm seeing it in both ways. So as far as vaccine delivery, supply, I've still been able to order all my vaccines, I've still been able to get access to the pneumonia, flu, shingles, et cetera. COVID in Florida [where Goldman is based] has always been difficult, especially when you have a surgeon general who's telling people not to get an mRNA vaccine, which, quite frankly, is horrifying to me that a physician is doing this because the mRNA vaccine, the platform of messenger RNA has been around for decades. That's not new technology. The application to a vaccination is, of course, what helped get us out of the pandemic. But to blanket statement that it's harmful is really irresponsible. So what I'm seeing for my patients having access to the COVID vaccine has become more difficult. I have patients who are 65 and up, which clearly is an indication, as well as there are other indications scientifically, but pharmacies are requiring them to get prescriptions, which creates further barriers to care, because they have to have a physician, they have to get a prescription. They then have to go to the pharmacy with the prescription, as opposed to being able to just go and get their vaccine. So that creates barriers, that decreases the availability. And when we look at the uptake, we have the issue of patients who are again unsure of what they should be taking. So they are now resistant or hesitant to wanting to accept these vaccines, when even previously they had accepted them. I had a patient today who was a little confused, but he said, I trust you, you are my doctor. And what I'm seeing in the real world is patients are trusting. Fortunately, many of them still trust their personal physician, even though they're getting all of this noise outside the office. So it's really incumbent upon us, especially as internal medicine specialists, to really understand the science, counsel our patients appropriately, correctly, avoid all of this rhetoric and noise outside the exam room, and continue to do what's best for the patients, to make sure they have the best information possible.

Related coverage: ‘Medicine is not political’ — ACP President Goldman discusses charged atmosphere around vaccines

Medicine under attack: How physicians can help their patients navigate the disinformation age

Medical Economics: What communication strategies do you believe are the most effective for physicians and other clinicians in countering vaccine misinformation and other medical misinformation?

Jason M. Goldman, MD, MACP: I wish I had that answer and in a tight, complete playbook. Unfortunately, I don't think there is one right answer. I've tried every strategy, and I really have to tailor it to the patient. Sometimes what has worked is taking a step back and saying, OK, what are your concerns? You don't want this vaccine or intervention or, for anything, medication, whatever it is. Why? What is it that you are worried about? Sometimes it's simple. It's, I have an event this weekend, I don't want to take the chance of getting a fever, can I do it next week? OK, fine, that's an easy one. But sometimes it's, I'm not sure what is the benefit? Why should I get it? Or I heard that it will cause all of these problems. And then you educate the patient, you go through point by point and say, you validate. Those are valid concerns, I understand why you're concerned. But here's the science, here's the data, here's why it doesn't cause the issues you're worried about for these reasons. Here's why it is beneficial and why you should take it. That's how it's supposed to be, where they have questions, we answer them, we have a discussion. The hard part is when it goes beyond that, and it's, we heard in the news, we saw this, or our political leaders are telling us that, why should we trust you over them? That's the challenging one when it comes down, not to, let's discuss the science, but who do we even trust? You know, and you can start with, well, you've been my patient for five, 10, years, I hope you can trust me, or else, why would you be here in the exam room? You've trusted me for your heart disease, your diabetes, your families come in, you've trusted me for all of this. Why on this one issue, do you now not trust me? So, you try and turn it around and say, OK, you brought up these concerns. Have you looked at the source? Where is that information coming from? Why do you trust them? What is your analysis of their recommendations and why? And you get them to try and question. But unfortunately, there are some patients who are so resistant, or people in general, they're so resistant to even having the discussion that it becomes a lost cause, unfortunately. Those are the most challenging ones that I still have not figured out how to reach because they have preconceived notions and nothing you tell them will change that.