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  • #46
    Originally posted by RJB View Post

    I am always as respectful and caring as possible, but I have no issues talking to my patients about obesity and smoking. Some of them don't like it, but it rarely leads to negative reviews and comments. I think there is something deeper with the vaccine. I just wonder if it is the "hill I want to die on" so-to-speak. I could spend 85% of a visit taking a great detailed history and formulating a big differential and diagnostic / treatment plan and really have the potential to make an impact on a patient's care, but if I lose them with a spirited debate about the vaccine, have I really been the best doctor I could have been?
    tough question.

    i have done a lot of vax counseling in the ED and i have probably convinced 20ish people to get a jab (who knows if they follow up for #2). i don't mean they promise they'll go get it i mean i order it and the RN gives it.

    i think this basically comes down to 2 questions:
    1. do you feel like it's your job to counsel pts for recommended screening and rx?
    2. do you feel like the crowd of people who are anti-vax deserve special exemption from said counseling?

    if you don't try, and that 55 year old dad of 3 w/ mild COPD goes on to die of covid, have you really been the best doctor you could?

    Comment


    • #47
      Originally posted by MPMD View Post
      if you don't try, and that 55 year old dad of 3 w/ mild COPD goes on to die of covid, have you really been the best doctor you could?
      This is probably more of a philosophical question since I know we could all counsel that smoker, obese patient, etc. a lot more than we do. In that way, I don't think any of us are being the best doctor we can be. There's always more to be done.

      Comment


      • #48
        Originally posted by RJB View Post

        I don’t disagree with anything you said, but I do also feel like, right or wrong, after I’ve engaged in a discussion with an antivaxxer, I’ve lost them. Maybe not as a patient. But I’ve lost them as a teammate in their care. I forfeit the ability to help them with the actual reason they came to see me.
        Read the last sentence. Not a thing wrong with discussing topics that are related to patient care. You do realize that vaccines have become politicized. Your conversation should not be a debate., simply a recommendation and IF asked the reasons. The patient will view you as trying to tell them how to live their lives. Vaccines and mask mandates seem to have morphed into a new religious zeal. I wouldn’t worry about surveys, I would think both you and your patients would be better served by staying in your lane. The purpose of the visit. Politics and religion should not impact your good intents.
        Personally, I would tone it down.

        Comment


        • #49
          Originally posted by Tim View Post
          Read the last sentence. Not a thing wrong with discussing topics that are related to patient care. You do realize that vaccines have become politicized. Your conversation should not be a debate., simply a recommendation and IF asked the reasons. The patient will view you as trying to tell them how to live their lives. Vaccines and mask mandates seem to have morphed into a new religious zeal. I wouldn’t worry about surveys, I would think both you and your patients would be better served by staying in your lane. The purpose of the visit. Politics and religion should not impact your good intents.
          Personally, I would tone it down.
          Well i definitely stay away from politics for sure. and religion only comes into play when the patient has question about the use of stem cells as it pertains to the vaccine. But when a patient says they dont want to get the vaccine because of magnetism, and because Bill Gates has too much money, or because it will mutate your DNA, or because its "experimental" I do feel I have an obligation (as a pulmonologist) to address this misinformation and attempt to convince the patient to reassess their decision. It very much is "my lane." My problem is finding the balance, I am sure Ive gone to far on more than one occasion, but like I said above...

          "I have tasted victory, I have received feedback both directly and indirectly that I have gotten through to some people, that I have changed some minds. I literally had a patient thank me for "cutting through the BS". I had a patient tell me that after my visit, she got online determined to prove me wrong, and then ultimately ended getting herself and her husband and daughter vaccinated. I'm not sure what the number needed to "treat" is, LOL, but it is not entirely a worthless endeavor....but at what cost?"

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          • #50
            Originally posted by FIREshrink View Post
            right, because what our patients want, what they think, and how they feel are completely irrelevant.
            What they want and what they MEDICALLY need are usually two completely different things. The vast majority of patient complaints are wants - they wanted to be seen sooner, they wanted the phone answered faster, they wanted the front office person to be friendlier. So yes, the vast majority of the time, it is irrelevant. Every rare now and then we’ll get a legitimate complaint, but believe me, those are incredibly rare.

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            • #51
              Originally posted by RJB View Post

              Well i definitely stay away from politics for sure. and religion only comes into play when the patient has question about the use of stem cells as it pertains to the vaccine. But when a patient says they dont want to get the vaccine because of magnetism, and because Bill Gates has too much money, or because it will mutate your DNA, or because its "experimental" I do feel I have an obligation (as a pulmonologist) to address this misinformation and attempt to convince the patient to reassess their decision. It very much is "my lane." My problem is finding the balance, I am sure Ive gone to far on more than one occasion, but like I said above...

              "I have tasted victory, I have received feedback both directly and indirectly that I have gotten through to some people, that I have changed some minds. I literally had a patient thank me for "cutting through the BS". I had a patient tell me that after my visit, she got online determined to prove me wrong, and then ultimately ended getting herself and her husband and daughter vaccinated. I'm not sure what the number needed to "treat" is, LOL, but it is not entirely a worthless endeavor....but at what cost?"
              You've practiced one way for years. Believed you practiced good medicine. I'm sure disagreed with some patients, had hard conversations, persuaded and dissuaded. Done all this and gotten PX scores in the 90s.

              Now have reason to believe discussions about vaccines are singularly tanking your scores. Admit you've "gone too far on more than one occasion"; that you "can't let it go"; that you are "somewhat aggressive"; that you've "lost then as a teammate in their care"; that the "doctor-patient relationship is fractured."

              You came here asking for advice. Like any good therapy patient you've solved the problem on your own. Whether you choose to follow your own advice is up to you.
              Last edited by FIREshrink; 01-21-2022, 08:28 AM.

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              • #52
                Originally posted by AR View Post
                No. I'm pretty sure there is such a thing. That is a really odd view. I'd be ok with "often your fault". But always? Come on.
                "No such thing." Never? Really?
                What you are saying is certainly true, but is it useful to think about it this way, if you have a certain goal in mind? If you are thinking in an “outcomes based” manner and wanting to change something, I think it’s best to focus on what you can actively do to effect the outcome. It’s the only variable that you can control.

                If something doesn’t work out the way we want, it’s natural to say, “I’m going to keep doing what I’m doing, I’ll just do it harder and longer”. But if what we are doing isn’t working, is doing even more of the same the solution? People hate changing, and hate to admit they are wrong.

                I think sometimes you have to decide if it’s worth the time and effort with some interactions. If it’s not, get the ************************ out of the situation quick. That’s the case a small percentage of the time. But if it’s happening 50% of the time, it may be time to look in the last place you’d expect to find the problem…. the mirror.

                Comment


                • #53
                  Originally posted by RJB View Post
                  Part of my job is to tell obese people that they are short of breath because they are obese, to tell smokers that no amount of inhalers will make them feel better until they quit smoking, to advocate for pneumococcal, influenza and COVID-19 vaccinations.
                  I totally get you're a pulmonologist which I would assume might easily lead to extreme frustration during a pandemic with >850K deaths.
                  But how much time and mental energy and effort are you spending on smoking cessation for instance compared to vaccine conspiracists? I am a psychiatrist but routinely ask pts about covid and smoking and weightloss etc. I very quickly can tell who to leave alone about the vaccine. Occasionally someone is on the fence or procrastinating and we have a discussion. All patients of course know they should stop smoking and lose weight so there's not much benefit in arguing with them about the need. You might look at motivational interviewing techniques if unfamiliar.


                  Comment


                  • #54
                    I am in the ED and I stopped asking people about vaxx status months ago. Those that are positive its matter of disposition. If you need to stay I recommend you stay. Those who agree will board in the ED for a long time. Those who do not leave AMA. Anyone else gets discharged. Come back if you cannot breath or feel like you need to be seen. If some ask me about if I believe in the vaccine I showed them my card and that is it. Purely transactional. I save my empathy for those who need it.

                    Comment


                    • #55
                      I am solo and hence any of these PG scores don't mean much to me. Google reviews or any of the healthcare reviews don't make a difference to my referral patter.

                      Having said that I don't like to be a jerk or bad*** since I respect my patients. I have many patients who smoke and drink excessively and as a oncologist I want them to quit the first and moderate the second. But I don't spend a ton of time on it, especially if the patients is turned off with my spiel.

                      I use the same approach with the vaccine.I only go into details if they seem interested. Otherwise I move on. When someone talks of the 65K deaths in this or that state, I can say I tried to counsel them but they chose otherwise. There is only so much one can do.

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                      • #56
                        Originally posted by RJB View Post
                        if I lose them with a spirited debate
                        Whether the advice concerns the vaccine, smoking, diet, wt loss, statin therapy, or anything else, it won't benefit the patient if you enter into a "debate." I provide patients with the medical evidence, while realizing that, in most cases, they aren't going to change their minds and/or habits.

                        I often begin by telling them that they are in charge of their own care. I am their consultant who is an expert on the matter under discussion. I provide the evidence and tell them it is up to them whether or not they want to follow medical advice. I find that approach helps, somewhat.
                        Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

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                        • #57
                          Dude, look around. The world is beyond lame:

                          We walk around with paper masks.
                          Cloth mask people or gaiter or bandana ppl are frowned upon.
                          No mask people can get in fist fights going to the grocery store in a lot of places.
                          Travel is neutered and unpredictable (bad quality for something that requires foresight and pre-payment).
                          We wear masks to parties... and not just masquerade masks anymore.
                          I get to wear a mask while I do deadlifts, yoga, basketball, etc at the gym. I get to wipe the basketball down with clorox wipes after (wtf?).
                          Youngsters do first dates on Zoom now. Baby boomers do the same.
                          We are probably going to spend 50% of your lives outside the house wearing masks for a dz that kills 1% (mostly oldies and fatties).
                          There is no end in sight.... only good COVID seasons and bad seasons, like the flu.

                          It is LAME. People are stressed and depressed.

                          If you debate or argue, you lose. If they win, you lose for arguing. If your logic is better, they hate you. Avoid it. You clearly need to re-work your scripts.

                          ...as docs, we make recommendations, that's all. You are probably failing to gain quick trust/rapport ("I like this doc") before advising, doing it in an abrasive or politic-charged way (very easy with the subject at hand), getting frustrated since you do the same (bad) speech so much, and injecting your own world views on citizens of a free country. Read 'How to Win Friends and Influence People.' Read Tony Robbins or watch the videos (Rapport YT video, Personal Power II might be best for this). Check out Charisma University. There are a ton of sources.

                          If you fail to create rapport first , then people don't even want to hear your recommendations. If people don't like your recommendations even if you got rapport and used humor or appeal to their health and happiness, who cares? Bill your 99214 and procedures or dx tests like the rest of us and go about your merry way... while the pt goes on theirs. I could care less if my ER consult with a shard of rebar in their liver or an open radius fx doesn't want surgery... the ER guy can do IV abx and a bandage and good luck to them.

                          Comment


                          • #58
                            Originally posted by RJB View Post
                            I am a pulmonologist. In the last year my patient satisfaction scores have dropped from the 90s to the 70s. The negative feedback from patients is predominantly related to my somewhat aggressive but always respectful recommendation to get vaccinated for COVID-19.

                            My question is how much should I care? How much should I care about my satisfaction scores, vs how much should I care about pushing the vaccine? Do I have a duty to advise my patients to get vaccinated, and attempt to correct the rampant misinformation in my patient population and continue to engage my patients? OR Should I just say, "you should get the vaccine if you haven't already" and then move on?

                            I know this isn't really about investing, but this is the best and most efficient way for me to get the advice from other physicians. Thank you in advance.

                            Ryan
                            You might change how you make your argument. Maybe it's not the most effective way you could be making it. Wouldn't hurt.

                            But in my experience patient satisfaction scores are never statistically significant anyway. It's like Google ratings. Look mine up some time for a laugh. Thousands of patients I've seen in my lifetime and how many Google ratings do I have? 4 (I get 1.8 stars on average). One from 2010, one from 2015, one from 2016, and one from 2017. I've got 5 reviews on HealthGrades. 4 of them said "difficult to schedule appointment." Yes, I only work in the ER where you can't make appointments. What makes you think patients surveys are any better?

                            So unless you're getting paid on them or it's affecting your job or practice in some way, who cares?
                            Helping those who wear the white coat get a fair shake on Wall Street since 2011

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