What this physician says to vaccine-doubters [PODCAST]

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“A scientific achievement can never have success on its own unless if it has acceptance in the social context by the masses. I think that the concerns brought forward by the vaccine-doubters cannot be dismissed as ignorance, and it is hard to convince people. As a physician, it is not uncommon that I see a patient become indecisive and anxious about various treatment decisions facing them. I don’t shy away from asking them to put their faith in me as their physician at moments like this. There is a simple strategy that makes the decision-making relatively easier, and that is to think of each patient as your own family member and recommend to them what you would want done if they were your own mother or grandfather. When presented this way, it usually goes very well with the patient, and a bond of trust is built, which ends up in successful care for the patient.

I would say the same thing to a vaccine-doubter. If I am being vaccinated myself as a health care worker and if I agree to vaccinate my children, please trust me that you should do the same.”

Farhan S. Imran is a hematology-oncology physician.

He shares his story and discusses his KevinMD article, “What this physician says to vaccine-doubters.”

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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 I share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Farhan Imran. He is a hematology oncology physician, and he wrote the KevinMD article “What this physician says to vaccine-doubters.” Farhan, welcome to the show.

Farhan S. Imran: Thank you. Thank you, Kevin, for having me. I love your podcast and the whole blog, so it’s an honor to be here.

Kevin Pho: I appreciate the kind words, and thank you so much for being on. We’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Farhan S. Imran: Sure. I was originally born in the northern part of Pakistan, in a town called Peshawar, and my medical school was Khyber Medical College. After finishing my training, I came to the United States, and I have basically been trained in Rochester, New York. That’s all my time in the U.S., except that I went and did my hematology and oncology fellowship at Georgetown University in Washington, D.C., and then decided to come back to my own institute, Rochester Regional Health, where I’ve been in a general hematology and oncology practice for more than the last five years now. I do see a lot of breast cancer, but otherwise I see all different kinds of cancers.

Other than the science of medicine, I also like the art of medicine, and that’s where I occasionally write a few things here and there. Thank you to your forum for projecting that to the world.

Kevin Pho: So we’re speaking towards the end of February now. From a pandemic standpoint, can you describe what you’re seeing in your hematology oncology clinic?

Farhan S. Imran: Last March, so we’re almost approaching the one-year anniversary of the pandemic. When it started in March, of course, all of a sudden it was a big unknown for everyone. In our oncology population, all of a sudden we all went to telemedicine visits, and we drastically cut down on in-person visits. Initially, we only brought in those patients who really needed the chemotherapy, but there were a lot of elective cancer surgeries that were delayed. We were worried that their cancer would metastasize.

But then, fortunately, where I am, in Monroe County, Western New York, the numbers initially didn’t go that high. So then we slowly opened up these visits, and we did not see a lot of our patients getting the COVID infection. Patients just did very well, actually. Later on, when the numbers got worse again, we again cut down on the number of actual visits for the patients, but by and large, all of our patients have been able to finish their treatments very, very successfully.

Now is the time for the vaccines, and in our region the vaccines opened up for patients who have cancer, so now our patients are slowly starting to get vaccinated as well. So I would say, overall, we did take a hit, just like everybody else, but our patient population did not suffer as we were initially expecting, which is a big relief, and we’re really thankful for that.

Kevin Pho: So you mentioned vaccines, and I think that’s going to transition nicely into what we’re going to talk about today. You wrote this article back in December. It’s titled “What this physician says to vaccine-doubters.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Farhan S. Imran: It’s very interesting. When the pandemic hit, for the first six to nine months, when there was no vaccine available, everywhere I would go, patients, friends, families, doctors, non-doctors, and health care providers, everybody would say, “Oh, what are we going to do? When are they going to come up with a vaccine?” And then I would hear comments like, “Why is it taking them so long? Why is the science so slow?” Then finally we had these Pfizer and Moderna vaccines come along, and I thought that it would just be a big home run and everybody would be flocking to get these vaccines.

But then I realized that some of my own colleagues, who are physicians themselves, and scientists, and it did not matter what their background was, what their level of education was, or what their understanding of the science was, but I started seeing a lot of people saying, “Hey, I’m not going to get the vaccine.” That struck me as very odd, as to why somebody is thinking along those lines. So that’s where I started thinking, and I just put down some of my thoughts in an article, just some aspects of my conversation, or what I would say to a person who is doubting whether they should have the vaccine or not.

Basically, you will read a lot of stuff about the scientific aspect of it, with people looking into the percentages of side effects and people looking into the short-term and long-term side effects and all that, which very appropriately should be done. But as we know, medicine is a big science, and we keep losing the art of medicine. So this article reflects more a physician speaking to a patient or a colleague physician from the heart, not about the scientific aspect of it, but from the heart, as to what I’m saying to a person who’s doubting getting the vaccines.

Then I approached it in a couple of ways. One way was that it depends on what’s going on, like people who are symptomatic. For example, if somebody has the actual COVID infection, or if somebody has heart disease, or if somebody has a pneumonia, and they walk into the emergency room, or they are in your hospital and they are short of breath or they are in pain, and we say, “OK, we have a treatment, we can give it to you,” nobody ever says, “Hey, I don’t trust this treatment.” At that point, they are jumping on getting any treatment. I mean, some of these COVID treatments were new treatments. Nobody who got admitted to a hospital with COVID infection ever doubted, and everybody said, “Hey, if there’s anything out there, even if it’s experimental, give it to me.”

But when it comes to asymptomatic individuals who are sitting at their home and have time to think, then they would start coming up with different reasonings. They would fall into the myths, they would fall into the conspiracy theories, and based on that, they would then not get the COVID vaccine, which is fine, if we say, “Hey, at the end of the day, it is your decision.” But on the other hand, people also have not seen what COVID can actually do. That’s why I sometimes joke with my friends that if HIPAA was not a big issue, what I would do is install webcams in COVID wards in all the hospitals in the world and live stream it, and you would see that everybody would be running to get those vaccines. So basically, that’s what I touched upon.

The other thing is the way medicine was practiced. It used to be very paternalistic. I mean, when we trained in the critical care ICU, the intensive care unit, I remember we used to have our attendings, and they used to come and say, “Well, you guys do these DNR/DNI discussions now, but 10, 20 years ago, the attending would write the names of the patients on the whiteboard, and then they would decide this person is DNR, this person is full code.” So that was very paternalistic. Then, when we were trained, it became very much focused on patient autonomy and making the patient make the decision, which is the right way to do it.

But I kind of feel like sometimes the pendulum swings too far. Sometimes physicians will go and provide all the data, a lot of numbers, and a lot of jargon to patients, and then leave them in the midst to make a decision on their own. My philosophy and my way of practicing medicine is to inform the patient and give them their options, but then truly think of them as your own family member and make the right decision for them, what you feel is the best for them, knowing how much you know about the patient. Then tell them, “Hey, this is the best decision for you,” and help them make the right decision.

So along the same lines, I said in my article that if I, as a physician, have decided to get the vaccine myself, if I’m going to vaccinate my children, and if you’re my patient and in my heart there’s nothing but well wishes for you, then you should trust me too, so as to build a trust that you should get vaccinated as well. So this is kind of an overall summary of my article.

Kevin Pho: So when you talk to your colleagues and some patients and they have some reservations about the vaccines, what are some of those reservations, and the reasons behind them?

Farhan S. Imran: The big one, which I totally understand, is that the vaccines were not studied well enough: “How could they come up with the vaccine so fast? It’s too new, and I’m not going to be the first person to get it. I’m going to see if some other people get it and how they do.” So that’s one of the big concerns. Other people are worried about side effects.

But it’s reasonable to tell folks that, first of all, the science is not new. The researchers have been working on it for a lot of years. It’s just that the research was really expedited during these emergent times. Also, when we talk about side effects, there are short-term and long-term side effects. For short-term side effects, we have thousands of patients in the clinical trials who went through the vaccine, and they had only, so to say, minor or moderate side effects. There are so many new drugs coming out in oncology and in every other discipline, where drugs have been researched in much smaller studies, but then they get approved by the FDA and they are given, and we don’t see any major problems.

Then it comes to the point of long-term side effects. That’s true for any medicine that comes out there: “Hey, there’s a new drug that was approved by the FDA six months ago. I’m giving it to you, but it has not been studied. We don’t have 20 years of data on that.” So if we start doing that for every new drug that comes out there, then, you know, that’s almost every drug. So these are some of the reasons with which I reason with folks who doubt whether they should get the vaccine or not.

Kevin Pho: We’re talking to Farhan Imran. He’s a hematology oncology physician, and he wrote the KevinMD article “What this physician says to vaccine-doubters.” Farhan, if you had a patient in the exam room who expressed some of these concerns and reservations about the vaccines, what are some specific things that you say to them to help build that trust and perhaps help convince them to take the vaccine?

Farhan S. Imran: Initially, of course, I do tell them. I go through the clinical trials, kind of go over them, and just review with them some of the side effects, which are very tolerable and not major. Then I tell them, and in fact I was just doing that 20 minutes ago with a patient, that many people who are quarantined, or now working from home, or not really socially interacting as much, are not seeing with their own eyes the catastrophe that this virus has caused. People usually think about mortality, but they kind of forget about the morbidity. Meaning, they say, “Hey, the mortality is very low, and chances are I may get the virus, but I may not die from it.” Well, that’s one thing, but if they can see how sick people are getting from it, and then, once they recover from the infection, how long-term those effects last. So the disease is very dangerous, and that’s how I try to convince them that, hey, the benefit is way higher than the risks of taking the vaccine.

Really, at the end of it, I don’t shy away from telling any of my patients, making it more of a humanistic kind of recommendation, that I took it myself. In fact, if anybody asks me, “Hey, did you take the vaccine? Should I take the vaccine?” my first answer usually is, “I took it. I took it, I took both the doses.” And right there, just that short phrase tells the patient that, hey, if the doc took it, I should take it too. Once I tell them I took it myself and I’m having my family members take it, and when it’s available to kids I’ll have my kids take it, that really builds that bond of trust between me and the patient.

Kevin Pho: And when you share these stories about the morbidity of COVID that patients may not be aware of, what are some of the reactions that you get from these patients that you tell?

Farhan S. Imran: Well, people do realize how deadly it is. People do understand that it is a dangerous virus. It’s just that, you know, that old adage: Your eyes don’t see what your mind doesn’t know. Somewhere along the same lines, you may have heard how bad the virus is, but once you’ve seen it with your own eyes, that’s really when you know how bad it is.

So I also tell my patients that we as physicians ourselves are not seeing COVID infections. In my oncology practice, I’m in the office most of the time, seeing my outpatients, who do not have COVID. But once a month, or once every six weeks, I go do the inpatient hematology service, and then I get bombarded with all these hematology consults for patients who are actually going through COVID infection. When I look at their scans, and when I look at their symptoms, and how young a lot of them are, and how sick they are, that’s where I all of a sudden realize.

So our patients, and the general population, know that it’s a bad virus and it’s a bad disease, but since they’re not dealing with it on a day-to-day basis, they don’t realize. So once they speak with us, it’s a nice reminder to them. It’s kind of the same as when patients come to the doctor’s office and we tell them, “Hey, what do you do for exercise?” and they say, “Nothing,” or, “I just walk my dog.” They know that they should exercise, but at every doctor’s visit you should reiterate some of these things, which are preventative methods: Go on a diet, lose some weight, exercise, don’t smoke. Vaccination is also part of the same. At each visit, we should take the opportunity to tell patients that it’s very important that they go through this vaccination.

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

Farhan S. Imran: My take-home message for the audience who are health care providers: I want to tell you all to take every opportunity in every interaction with any patient to reassure them. This is a very difficult time, this pandemic. No living person has ever lived and seen a pandemic, and people are scared, people are worried, people are anxious. They don’t know what to do. It’s a big fear of the unknown, and the health care community is the leader in fighting this pandemic. So if your leaders, the guardians of your health, are making this decision and giving you a recommendation, then they should also, you know, follow suit. So that’s what I would recommend.

To the patients, I would say we understand that, you know, many, many treatments are new, and there could be some concerns, but at the end of the day, trust is a big thing, and they should trust their doctors, trust their nurses, and trust their health care providers. Together we have hope. We’re already seeing the numbers going down, and hopefully soon, within the next year or two, we’ll overcome this pandemic.

Kevin Pho: I hope so. And how can people reach you?

Farhan S. Imran: Actually, one easy way: I blog at my website. It’s called didiask.blog, D-I-D-I-A-S-K dot B-L-O-G, didiask.blog. If they go there, they will see some of my blogs, and there’s a contact form where they could contact me and also read some of my other articles. I’d be happy to hear their comments.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Farhan S. Imran: Thank you, Kevin.

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