Captions on the COVID vaccine selfie matter as much as the picture [PODCAST]

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“For a vaccination campaign to be highly effective, we need to be open to having difficult conversations with people who disagree with our perspective. If we don’t, the result will be a polarization of philosophical ideas and not an unbiased and unemotional assessment of the data where maybe we can meet in the middle.

As we share our pictures and experiences regarding getting our vaccines, let’s try to admit what we know and, more importantly, what we don’t know. Let’s not speak down to those who have questions. And let’s not be afraid to say that maybe we are a little afraid ourselves of some of these unknowns but that we are willing to take the potential risk of getting a vaccine because over the past then months, there are a few more knowns about the actual virus that scare us even more.

Happy conscientious and kind posting.”

Alicia Billington is a plastic surgeon.

She shares her story and discusses her KevinMD article, “The COVID vaccine selfie: The caption matters as much as the picture.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system that are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we welcome back to the show Alicia Billington. She is a plastic surgeon, and she wrote the KevinMD article “The COVID vaccine selfie: The caption matters as much as the picture.” Alicia, welcome back to the show.

Alicia Billington: Thank you so much for having me back again. I always enjoy spending time with you, and this is such a privilege to be here.

Kevin Pho: So we’ll get into your article in a little bit, but for those who didn’t listen to your earlier podcast, can you briefly share your story and your journey to where you are today?

Alicia Billington: Sure. So my background is as a plastic surgeon, but I love math. I love statistics. And in the setting of COVID, it has been very frustrating observing all the misinformation and people not really understanding the statistics that are going on. And so it just kind of got under my skin. It was bothering me, and I wanted to do something about it, and so that’s sort of how I came up with the idea behind this article.

But I’ve been very involved in medical advocacy dating back to when I was in medical school. It’s something I’m passionate about. I think it’s something that all physicians really should be involved in, because if we’re going to really help our patients, we need to do it not only in the operating room or in the clinic. We also need to have a voice for them, speaking with members of Congress and helping elicit change in regards to our health care system in general.

Kevin Pho: Well, I completely agree with you, and I believe we last spoke in the summer. So tell me how the physician voice has changed. Has anything changed from the summer to now?

Alicia Billington: I think so. I think that the coronavirus has made it so that everyone has to be educated on the topic, because patients will come in from a wide variety of backgrounds, and it doesn’t matter whether you’re an internal medicine doctor or whether you’re a plastic surgeon like me. Patients are going to ask you about it, and you really have to be up to date. You have to know about not only what’s in the medical literature, but also what the misinformation is on Facebook.

And what I’ve seen is a lot more physicians who were hesitant or afraid of engaging in social media before, for many understandable reasons, are now becoming more involved and having more of a voice. And I think that’s really important, because you have to have experts who are speaking on these social platforms, in addition to people who maybe are spreading some misinformation and think that they are knowledgeable about it. And I think it’s probably been the single greatest attack of physicians against misinformation that I’ve ever seen, because we all share the common goal.

And because COVID has been such a big deal, I think there have been a lot of other issues that have been important, but people were afraid to have a voice, or there were so many issues to pick from. It wasn’t that there was one unified thing. This is different. This is something that is affecting everyone, and every physician is involved in it.

Kevin Pho: Can you share a story of a piece of COVID-related misinformation that you may have seen online and what you did about it?

Alicia Billington: Sure. So there’s been a lot of information out there that has a little bit of truth to it, and I think those are particularly the scary ones. So there is one that I saw about doing the nasal swab, where you do the nasal swab to test for COVID, and they were saying that it was implanting a chip into the brain. And that’s scary. I mean, seeing that as a patient, that’s terrifying.

That’s an area of the body that I happen to operate around, so it was something where I could say, “From my perspective, I know this anatomy really well, and that’s not possible.” And also, I happen to know someone who is fabulous, who created these 3D nasal swabs that we use at the University of South Florida. And so I said from that perspective, from an engineering perspective, it also isn’t feasible that there’s a microchip there. So that’s one example of misinformation. And what I did was I just said, “Let’s talk about why you’re afraid of this, why you think it might be true, and here’s some evidence and some reasons why that doesn’t make sense.”

Kevin Pho: And how did that patient respond to you?

Alicia Billington: Very well. I was extremely impressed. I try to meet people in the middle, because a lot of times I learn from my patients that the fears that they have are grounded. I mean, there’s sometimes some truth, some nugget that someone has given them. And I say, “You know what? You’re right about that. That is true, but let’s explore X, Y, and Z.”

And I think if you meet them in the middle and say, “This makes sense, and this part doesn’t,” you’re not saying, “Well, that was stupid. You’re totally wrong.” Because the other thing about coronavirus is we don’t know a lot about it. We’re still learning every day, and we need to be able to say, “Well, I think this is what’s going on,” or, “You know what? I was wrong,” because there was a lot of going back and forth about the masks. So I think it’s really important just to be honest with your patient, but to meet them in the middle.

Kevin Pho: All right, so let’s transition now to your KevinMD article, and it’s titled “The COVID vaccine selfie: The caption matters as much as the picture.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Alicia Billington: Sure. So I was really nervous about the vaccine rollout, because I thought, “Oh my gosh, here is our chance to totally screw up decades of good research with vaccines.” I was worried about how the rollout was going to happen. I was worried about them testing appropriately, getting enough data. I was worried about them rushing it, pretty much all things I think most Americans are very worried about. And I thought, “Gosh, if we get this wrong, I’m worried about parents not treating kids to prevent measles and people not getting the flu vaccine and all these other things.”

I was totally shocked. I was pleasantly surprised. The studies were done extremely well, and what I thought was cool was there’s this coordinated, unwritten effort where everyone who got a vaccine started putting up vaccine selfies. And what I noticed was patients who were kind of on the fence or weren’t sure were responding more positively to people who came out and didn’t say, “I did it, you have to do it, you’re wrong if you don’t,” if they had a conversation.

And so when I put up my post, I said, “You know what? I was scared about this, and I researched the heck out of this, because I wanted to make sure it’s the right thing to do.” And so that’s why I said that the words matter as much as the picture. The picture draws you in, but the words matter, because it’s going to be what tells a patient, “Maybe this is right for me.” And so it was really cool to see a lot of physicians come together in a positive way, in an educational way. And so that’s kind of why I wrote it, because I want people to post those pictures, but I also want them to have a message that will engage and encourage people versus deter them from getting it.

Kevin Pho: So over the course of your practice, in your workplace, have you noticed any resistance to the COVID vaccine or any hesitations?

Alicia Billington: I have a lot. I’ve seen it from some of the nursing staff that I’ve worked with, and certainly a lot of patients. And here’s the thing: This is a choice, and I want everyone to make an educated choice. And at the end of the day, if someone says, “I’m not doing it, you can’t make me,” they’re absolutely right. This has to be something that they want to do.

So I’ve sat down and I’ve talked with nurses and said, “Well, what scares you? What bothers you? What’s the science that you’re afraid of?” And we talk about it, and a lot of times they bring up really good points. But when we work through it, they’re like, “You know, I never thought about it like that.” And we look at the numbers of how many people are dying from COVID versus how many people are having an anaphylactic reaction from the vaccine, and they’re like, “Wow, I never thought about comparing those numbers. Yeah, it kind of makes sense for me to go ahead and get that vaccine.”

The other thing is, a lot of the stuff on Facebook is really where patients are getting their information from. And so I actually had a patient an hour ago, a very nice older lady, and we were just kind of talking. I give everyone a COVID test before I operate on them, to protect not only the patient but also the staff. And I said, “Are you going to get your COVID vaccine?” She goes, “Oh, I just don’t know. I have a lot of questions.” And it struck me: This was it. This was her opportunity to talk to a doctor about the vaccine, and she’s not getting them anywhere else. And so that’s why I think it’s so important that every physician be knowledgeable, to be able to talk to their patients about it, because it might be a plastic surgeon telling them information that could potentially save their life.

Kevin Pho: So when you talk to other health care staff who are hesitant about the vaccines, walk me through one of those interactions that you have with them. What are their concerns, and what are some specific things that you say to alleviate those concerns?

Alicia Billington: I think the first thing, and this is something that family members have asked me about too, is, “Wasn’t this rushed? Didn’t this happen too fast?” And the answer is, it was fast, but it wasn’t too fast. This was something where all of the rules were followed. A lot of the red tape was removed, and a lot of the red tape also involves financial difficulties and raising funds to get vaccines through. The government stepped in, and they said, “Look, we’re going to buy a lot of vaccine whether or not it works, so that we can encourage you and help you to get through this process faster.”

And then, listening to experts like Dr. Offit on the FDA panel, who has worked on vaccines himself. I mean, he came out and said, “I’m kind of worried about this going through too fast and this working.” And then he came out later and said, “Man, this is a really effective vaccine. The data is extremely impressive.” So listening to people who came in and had an open mind about things but asked a lot of questions, hearing those people come out and say, “Yeah, this is really effective,” was very powerful to me.

So some of the things that I say are, if you look at the death rate, and there are various percentages, so I hesitate to quote, but around 1.6, maybe, of people who get the virus may die from it. Versus, if you look at the anaphylactic reactions, I think now with the Pfizer vaccine it’s down to about five per million, and with the Moderna it’s about, I think, two and a half per million who have an anaphylactic reaction, which is treatable, and they have you sit for the 30 minutes. When you look at what that percentage is, it’s such a higher risk of having a negative outcome from the virus than from having a treatable negative outcome from the vaccine. And when I put those numbers next to each other, I think a lot of times everyone goes, “Oh, I didn’t think about it like that.” And so that number is very powerful, I think.

Kevin Pho: Now, of all the vaccine-hesitant patients and health care members that you talk to, how often would you say that you’re able to change their minds and make them think twice about actually receiving the vaccine?

Alicia Billington: You know, at the end of the conversation, I don’t say, “Did I change your mind?” Instead, I say, “If you have more questions, I really want you to come back and talk to me about it.” It’s really important, and I learn from it too. Sometimes it pushes me to read more about a topic related to vaccines or to COVID that I didn’t know about before. I have had a couple of people call me back and say, “I went and got the vaccine,” but I don’t keep a tally, because to me, it’s not about winning. It’s about providing information.

I will say every single person that I’ve talked to said at the end, “Thanks for talking to me about it.” And to me, that’s the whole point. That is winning. If people have the knowledge and they make the decision, if it’s not a decision to get the vaccine, it’s at least a little bit of a more educated decision, and I feel like I have won. Or not one, but we have all won.

I’ve also had people call, and maybe they got the vaccine but their spouse didn’t, and they’ve asked me to talk to their spouse, and I have. And they still didn’t want to get the vaccine, but one member did and one member didn’t. And so I’ve seen that, and I’ve seen how difficult corona is on families, because families are split a lot of times in their beliefs about it. And so to me, it’s not about winning. It’s just about, “Let’s get you the information.” And that’s hard, because you want to know, “Yes, I was effective, and it worked,” but that’s just not how it pans out. Sometimes you just don’t know.

Kevin Pho: We’re talking to Alicia Billington. She is a plastic surgeon, and she wrote the KevinMD article “The COVID vaccine selfie: The caption matters as much as the picture.” Alicia, we’re speaking at the beginning of February, and we’re going to have months and months of vaccines to hopefully end this pandemic. Now, right now, what’s the single most powerful thing that physicians can do to continue advocating for the vaccine?

Alicia Billington: I think every single day you have to read about it. I have multiple medical sources and news sources that I pull from, and I go to the primary data. So when the vaccines came out, I didn’t just read what was in the news. I actually went and scanned through the 5,000-plus pages that went to the FDA. And obviously we don’t have time for that, but I think at least being aware of what the hot topics are and being able to speak to your patients about that is important.

And I would say it’s really important that we have a unified front, that every single physician is talking to their patient about this, regardless of whether you consider yourself someone who typically would be having those discussions on vaccines, because in a setting of COVID, where people aren’t going to the doctor that much, you might be the only physician that they have contact with for months. So I think that that’s really important, and talking to family and friends.

I do think being on social media is important, but being on social media in a positive, kind way. It’s so easy to get on there and say, “I’m a doctor, I’m right, you’re wrong.” That doesn’t help anybody. We really have to meet people in the middle and find out what their fears are. And you know what? Sometimes we’re wrong about things too, so admitting when we’re wrong is important.

Kevin Pho: And my final question: your take-home message that you want to leave with the KevinMD audience.

Alicia Billington: I just hope that every physician who’s listening out there, every nurse who’s out there, gets involved. Advocate for your patients, because it is so much more than just the work that we do in the office, in the operating room. We need to be our patients’ voice, and that means talking to the patients, listening to them, finding out what their hopes, dreams, and fears are, and then representing them. I think we really do owe it to our patients to be involved in medical advocacy. That is a passion that I have.

And also, patients: I think it’s important to advocate for yourselves and to bring good questions to your doctors. So it’s a joint effort. But I really do hope that. And that’s one of the passions I have in my life, to help improve the health care system in our country and to advocate for our patients and each other.

Kevin Pho: Well, thanks again for your time and insight, and thanks again for coming back on the show.

Alicia Billington: Thank you so much for having me.

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