How to get patients vaccinated against COVID-19 [PODCAST]

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“While opposition to the vaccine may be hardening, pediatricians and family physicians enjoy an advantage the CDC and Dr. Fauci may not: namely, they are liked and trusted by patients. In general, parents look to personal physicians for guidance and usually follow their advice on health care for their children. Doctors can use that trust to convince skeptical parents of the benefits of getting their children vaccinated.

Even the medical office setting can be an advantage. Unlike a bustling pharmacy or a crowded mass vaccination site, a doctor’s office offers a low-key, familiar environment, one in which a parent might be more open to counseling.”

Rich Parker is an internal medicine physician.

He shares his story and discusses his KevinMD article, “How to get young patients vaccinated against COVID-19.”

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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 but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Rich Parker. He’s an internal medicine physician and health care executive, and he wrote the KevinMD article “How to get young patients vaccinated against COVID-19.” Rich, welcome to the show.

Rich Parker: Thanks, Kevin. Great to be here.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Rich Parker: Sure. Well, the very quick story is that in college I majored in East Asian languages and civilizations. I took no premed courses, and then a year later a little light went on that I wanted to be a doctor. So I went back to premed courses, went to med school, and did my residency here in Boston at the Deaconess Hospital, and I was an internist there in a very busy ambulatory practice, also seeing my own inpatients, for 25 years.

I also became the medical director for the physician organization, and I learned a lot about the politics, the business of medicine, organizing doctors, and leveraging IT. I became their chief medical officer, and then in 2015, after 30 really wonderful years at BIDMC, I got an offer to become chief medical officer for Arcadia, which is a health care IT company. We aggregate big data for ACOs and supply analytics for the purpose of population health.

Also, just some other things I do: I work for Care Dimensions hospice on weekends. I see patients again, and I found that tremendously gratifying. I also volunteer for NAMI, the National Alliance on Mental Illness, as a family support group facilitator for families that have a loved one with severe mental illness.

Kevin Pho: I’m always interested in hearing the stories of physicians using their degree outside of clinical medicine, and you are certainly in the health care executive ranks. Tell me a little bit about that transition: any potential challenges that you face when making that transition?

Rich Parker: Well, part of the challenge is wanting to see patients and be an executive at the same time. I know a lot of my CMO colleagues and medical director colleagues around the country face this challenge: We don’t want to give up patient care, because that’s really where our heart is, and it also gives us credibility as an executive. But there comes a point where you can’t do both well, and it just becomes overwhelming. So I reached that point in 2012, where I did stop seeing patients and devoted my energies full time to CMO.

Kevin Pho: Now, for those physicians who are interested in entering the health care executive ranks, potentially as a CMO of a health tech company, what type of characteristics should that doctor have?

Rich Parker: Well, first of all, I think people have to have at least 10 years of practice under their belt. I think it’s really hard to aspire to become a medical director or a CMO if you haven’t worked in the trenches for the better part of 10 years seeing patients, and you really know what it’s all about, the challenges that the patients and their families face.

Then in terms of medical director and CMO opportunities, there are so many. It could be within your own institution, and there I advise young doctors to volunteer for committees, which may sound a little bit boring, but that’s how you learn how the sausage is made. So get on the credentials committee, get on the quality committee, get on the, you name it, committee, and start learning. And then they start to see, “OK, here’s a person who’s willing to volunteer some of their time to learn.” That’s actually how I became medical director at BIDMC.

Kevin Pho: Is there any specific training physicians should have before they enter a CMO role? You did mention going to committees and learning on the fly, but any type of formal training, for instance, a business degree?

Rich Parker: I think it can be done either way. I did it from the grassroots, kind of from the street level, to mix metaphors, and that worked pretty well for me. But I do know that some doctor colleagues either go to business school, or I know that Brown has a master’s degree in policy. So I think these degrees are useful, but I wouldn’t say as a general rule that one way is better than the other. They both have their pros and cons, and you have to decide, for your personality and your goals, which works better for you.

Kevin Pho: All right, let’s transition now into the KevinMD article that you wrote. It’s certainly relevant now in the fall, during the school season. It’s titled “How to get young patients vaccinated against COVID-19.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Rich Parker: I’ve been an advocate for the COVID vaccine since the vaccine came out, before the vaccine came out. I feel passionately about this from a public health perspective, and I wanted to veer off a little bit from my internal medicine roots into the world of pediatrics, because we’re now coming upon the time when the vaccine will be available for children age 2 to 12, very shortly, hopefully by Thanksgiving, maybe even before. I just wanted to give a little heads-up to our pediatrician and family practice colleagues that they need to get ready for vaccinating children and not be taken by surprise.

Kevin Pho: So when you say they need to get ready and not be taken by surprise, what are you expecting them to face?

Rich Parker: Well, they’re going to face a lot of pushback from parents who, for a variety of reasons, do not want their children to get vaccinated. So they need to be prepared to spend time in those discussions with reluctant parents and do a lot of listening and less talking.

Kevin Pho: Now, when you talk about the COVID vaccine, from your experience, what are the areas of pushback that you’re finding patients are asking their doctors about?

Rich Parker: There are a few areas of pushback. One is, I had a conversation yesterday, in fact, with an employee who said, “I’m just waiting. I need more time to make sure for myself that the vaccine is safe and effective.” So there’s that.

There is also, and this varies by state and even county, a kind of American cultural, anti-government, not-trusting-the-government thread that’s very deep in the fabric of our culture, and that is leading people to just question anything that the federal or the state government says you should do. People reflexively say, “Well, therefore, I won’t do it.”

Kevin Pho: Now, when talking to patients who are a little bit hesitant about getting the vaccines, what type of techniques do you recommend, or what kind of stories can you share that can help clinicians in the exam room?

Rich Parker: Right. So what I have heard from my colleagues around the country is the technique that we doctors know, called active listening, is really the heart of the matter. It’s a little counterintuitive, because you might think that we need to be prepared with a script to tell patients exactly what they need to hear about why the vaccine is safe and effective and good for you. But it turns out that what we might call the paternalistic approach is not the most effective approach.

It appears that the more effective approach is doing less talking and more listening, and asking the patient, in this case the parents, “What are your concerns?” And then close your mouth and listen. After the parent, or parents plural, have expressed their concerns, you have a chance to dispassionately and calmly discuss the facts, F-A-C-T-S, the facts for them, that hopefully will get them to the point where they’re willing to allow vaccination for their children. I would also point out that it might not just be one conversation. You might plant the seed in the first conversation, and then they have to come back and talk about it again.

Kevin Pho: Pediatricians in particular have been dealing with vaccine hesitancy for a while, of course, with a variety of childhood vaccines. There’s some pushback on that. Is the COVID vaccine different from the hesitancy that they’ve historically been facing?

Rich Parker: Great question. This vaccine hesitancy movement really goes back to 1905, when the smallpox vaccine was mandated by the U.S. Supreme Court in Massachusetts, in a case called Jacobson v. Massachusetts. That anti-vaccine movement has been here and active for at least 116 years, and probably before that.

What’s different about the COVID vaccine, unfortunately, is that it has become so politicized in our red-blue, very divided country. It is heartbreaking to me, as a doctor interested in nothing more than public health, that the politicization of this topic has resulted in millions of people not getting the vaccine, hundreds of thousands of unnecessary deaths, and, in this case, many children who are not going to get the vaccine, no fault of their own, who now may get infected and have really adverse consequences.

Kevin Pho: And against that backdrop of the vaccine being highly politicized, and amplified by social media, of course, what are clinicians able to do to fight against that context?

Rich Parker: I think clinicians need to remain true to our profession, which is that we are here to serve the public. We are here to care for the public. We take a lot of hits as doctors and NPs and PAs and nurses and social workers, but that’s our job, and we have to stay strong and not be discouraged. It’s the long fight. It’s not a sprint, it’s a marathon, to use a metaphor.

And know that we are right in supporting a safe and effective vaccine that is frankly miraculous, that our scientists were able to bring this forth so quickly, and that we could be grateful that we’re a country that has access to plenty of vaccine, unlike so many countries around the world that can’t even get the vaccine, and they want it. We have more than we need, yet people will not take it. So I think, given that, we just need to stick to why we became doctors, and true to our calling, which is to serve the public, and not waver.

Kevin Pho: We’re talking to Rich Parker. He is an internal medicine physician and health care executive. He wrote the KevinMD article “How to get young patients vaccinated against COVID-19.” Rich, has there been a case study or story that you could share, where you talked to someone or a patient who was initially hesitant to get the COVID vaccine, and your techniques or your conversations with them convinced them to go ahead and get one?

Rich Parker: Yes. I get to talk with the employees for my company. They call me about all manner of medical things, and I had one employee who initially was quite reluctant. She had anxieties about the vaccine. She was concerned about side effects that she read about in the media, and we had a series of conversations, some by phone, some via email, and over time she decided to get the vaccine. So for me, that was a win, and it was very gratifying.

Kevin Pho: I think your story certainly highlights the serial nature these conversations sometimes have, and demonstrates the importance of having a relationship with whomever you’re trying to convince to get the vaccine. And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Rich Parker: Get vaccinated, and remember that the life you save might not be your own.

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

Rich Parker: Thanks, Kevin. It was a pleasure.

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