How docs can meet vaccine hesitancy with empathy

Docs shed paternalistic patient-provider relationships

The notion of integrating the patient as a member of the clinical care team is relatively new, Abelowitz suggested. It wasn't long ago that physicians were educated under a more paternalistic approach to medicine in which the physician was the sole decision-maker on a patient's care plan.

But that's not the state of medicine anymore.

Value-based care arrangements have pushed the notion of patient engagement, lending to more shared decision-making across the care continuum. Patients no longer simply receive care; they help inform it, too.

That's actually led to better patient-provider relationships and, ultimately, better adherence to clinical guidelines, Abelowitz said.

"I've learned over the years that you need to be aware of all the angles and issues that concern caregivers," he explained. "You need to work with parents and collaborate as a team together regarding all clinical aspects, but especially with vaccines it has far better results."

Abelowitz has learned that he can help parents and caregivers better understand vaccines when he takes the time to better understand their concerns. In most cases, a vaccine-hesitant caregiver is simply afraid of the potential harm they think a vaccine could have.

To be clear, vaccines are safe and effective and are public health's best tools to reduce many preventable illnesses. But the rise in medical misinformation on social media, plus the cultural distrust in some public health entities like the CDC and WHO, have caused some parents and caregivers to doubt.

"We spend more time listening to parents, we spend more time asking them about their concerns and we spend more time giving them new information and understanding," Abelowitz said of his practice.

Making time for deep patient-provider communication

It's not lost on Abelowitz that his practice is in a unique position to spend so much time discussing vaccines with patients. Ocean Pediatrics is a private, independent practice that Abelowitz said has a boutique feel. Although every primary care provider faces a time crunch, Ocean Pediatrics has some flexibility.

"Yes, it's a challenge with time because you have so many issues you're dealing with," Abelowitz pointed out. "But if a patient needs 30 minutes to talk about vaccines, we'll do it. We don't over schedule, and we don't overburden."

Not every healthcare organization has the freedoms Ocean Pediatrics has to dedicate to vaccine discussions. Abelowitz acknowledged it's tough to put patients first in offices where physicians can't control their own schedules or there is a stronger culture of productivity.

"If the patient needs more time, we'll give them more time. But how do we adapt to it? Because obviously, you can't spend two hours on vaccines," he noted. "We have a business to run, too."

Foremost, Abelowitz and his colleagues start talking about vaccination when patients are newborns. That way, the pediatricians at Ocean Pediatrics can immediately identify caregivers who might need more attention in terms of vaccine hesitancy.

"We've already chipped it away over time," Abelowitz explained. "So, providers are not pressed on that visit, and parents are actually prepped. We also give caregivers information and handouts and send them to the appropriate websites."

Ocean Pediatrics also leverages team-based care and leans on nurse practitioners and physician assistants/associates when families stick to the typical vaccine schedule.

Patient partnerships are essential moving forward

Practicing empathy isn't necessarily the hard part of addressing vaccine hesitancy, Abelowitz suggested. Most clinicians are, by nature, empathetic people. But as vaccine hesitancy becomes an increasingly pressing issue, clinicians need to shake off the power hierarchies that have long defined the healthcare experience.

"You learn over the years to understand people better," Abelowitz said. "It's not that they're challenging you as the pediatrician -- it's about the loss of trust in the system, the misinformation and the overexposure to other sources of information."

By understanding the biggest fears and concerns of parents and caregivers, pediatricians have the tools to be more empathic in their conversations. This will be important as clinicians like Abelowitz continue to monitor increasing levels of vaccine hesitancy.

"The concern is that as hesitancy increases, the percentage of the folks getting the vaccines decreases, and the protection decreases," he concluded. "We're going to see potentially even exponentially more numbers of these cases, and this could be a major concern."

Sara Heath has covered news related to patient engagement and health equity since 2015.