Public perception of doctors has changed, and so has the effort physicians must put into getting through to difficult patients.
A physician’s primary responsibility is to provide expert guidance on patient health, according to Michael Grosso, MD. For as long as the profession has existed, patients have mostly taken that guidance seriously.
But in the 21st century, much has changed. Physicians occupy a new role, akin to a “patient consultant,” Grosso, Medical Director and Chairman of the Huntington Hospital Department of Pediatrics, told MD Magazine. Patients have changed too. Now, they’re the chief executive officers of their own health.
Patients “may feel that it would be appropriate to take the advice at some times and reject it at other times, and that’s sort of a social demotion [for physicians],” Grosso said. “It’s a little unsettling.”
For pediatricians like Grosso, much of that unsettlement stems from the recent trend of vaccine reluctance. Grosso said it’s not uncommon for pediatricians to discuss the frustrations surrounding the anti-vaccination movement with their peers. Beyond venting, the conversation has swelled to a national arena — it’s been revived as a topic of academic research and podium presentations across the US.
Federal and global entities are dedicating time, effort and funds to persuade patients of the proven safety and efficacy of vaccinations, and to dismantle the arguments presented by anti-vaccination communities. The World Health Organization’s Global Vaccine Safety Initiative page lists 6 of the most common misconceptions about vaccinations, with evidence to refute each point, backed by clinical research.
The US Centers for Disease Control and Prevention (CDC), during its National Influenza Vaccination Week campaign this week, provided flu vaccination guidelines and a list of patient groups most at-risk for flu-related complications.
There’s even been research put into better understanding the rhetoric of anti-vaccination. A study published online in Social Science & Medicine this October sought out the geographic and demographic characteristics of expressed beliefs that childhood vaccination is correlated with autism spectrum disorder — on Twitter.
Study authors analyzed 272,546 tweets related to anti-vaccination between 2009 and 2015, and found that Twitter users from 5 states (California, Connecticut, Massachusetts, New York, and Pennsylvania) had a significantly higher rate of related tweets.
The high rate of tweets that expressed anti-vaccination beliefs correlated with the topic’s rise to the national spotlight, according to the authors. Using available demographic tools, researchers pointed to women who recently gave birth, residents of high-income households, men aged 40 to 44 years old, and men with minimal college education as most likely to express anti-vaccination beliefs on the social network.
Researchers suggested monitoring Twitter to uncover concerns and misconceptions, gauge public opinion, and aid pediatricians in refuting the anti-vaccination argument.
“Real-time interventions are needed to counter anti-vaccination beliefs online,” researchers wrote. “Identifying clusters of anti-vaccination beliefs can help public health professionals disseminate targeted/tailored interventions to geographic locations and demographic sectors of the population.”
These additional efforts, especially in direct conversations between physicians and parents reluctant to vaccination, affects practicing pediatricians to a “very extensive degree,” Grosso said.
“There’s a lot of controversy, as a matter of fact, about whether pediatricians should be dismissing from their practice parents who refuse to immunize their children,” Grosso said. “That’s a bioethical debate, about whether that’s an appropriate or inappropriate thing to do.”
There’s reason to wonder whether such a measure would help or hurt vaccination rates. According to the CDC, 2016 national vaccination rates for tetanus, diphtheria and acellular pertussis (Tdap), meningococcal conjugate vaccine (MenACWY), and human papillomavirus (HPV) in adolescent patients are ahead of goals set for 2020. The adolescent population between ages 13 and 17 were estimated to have better immunization rates in each of these areas compared with previous years.
According to data shared by the Organization for Economic Co-operation and Development (OECD), in 2015, about 95% of US children around the age of 1 were vaccinated for tetanus, diphtheria and Tdap, and 92% were vaccinated for measles. Those annual rates are consistent with previous years — 94% and 91% of children, respectively, had the same vaccinations in 2000.
LJ Tan, MS, PhD, chief strategy officer for Immunization Action Coalition, told MD Magazine that there’s still room for improvement in adolescent-age booster vaccine doses. Less than 40% of adolescents received the recommended second dose of MenACWY vaccine, versus the 82.2% who received the first dose, in 2016.
Additionally, less than half of adolescents received the flu vaccine in 2015, Tan noted. He emphasized the need to help the age group “begin to own their own health.”
“There’s still a lot of parental guidance and influence in vaccination progress,” Tan said. “The messaging to the older teens is a little bit different. That’s something we try to pay attention to in our group.”
These efforts are supplemental to the CDC’s Vaccines for Children Program, which already responds to rural areas, minority groups, or low-income family populations with cost- and burden-free care. Though it’s a public health service born out of necessity, it could also serve a population able, but unwilling, to comply with vaccination recommendations.
These measures allude to Grosso’s point that physicians no longer guide — they consult. Brushback from patient controversies like anti-vaccination could change the scope of primary care.
“There's a general lack of respect for all professions — politicians especially, and lawyers – but for a long time doctors held out,” Murray said. “We were not really included, but we're seeing more and more of this disrespect toward us.”
Despite acknowledging this development, Murray and Grosso advocated for the same approach when dealing with difficult patients: empathy.
“I don't want to be rushed by doctors. I don't want to be scolded, and I don't want to be berated for what I'm not doing, so I try not to do that with other people,” Grosso said. “We're all patients at some time, so I think if you remember that, it goes a long way in helping you get along with people.”