When the COVID pandemic first reared its ugly head in 2020, I was mentally prepared (as much as any of us could be) for the patient care wave that was coming our way. What I was not prepared for was the mass of anti-science and anti-intellectual pushback that we have seen over the past one and a half, almost two years, in regard to the virus itself and the vaccine.

To say I felt, and at times continue to feel, anger and frustration to unimaginable levels would be an understatement. I’ve lost count of how many times I have had to call a friend to scream and vent (or do the same at my therapy sessions). Even simply asking a patient if they have been vaccinated or if they have any questions has resulted in said patient taking off on a tirade about how dangerous the vaccine is and how they will never get vaccinated. I have no doubt that fellow colleagues reading this have had many similar encounters and have felt the same anger and frustration.

Even though most of us are very good at following the evidence, I have also seen that we have done a bad job in communicating that evidence to our patients as health care providers. It’s one thing for us to talk with each other and lament how patients don’t understand the science or how easily taken in by some YouTube video and conspiracy theory.

Unfortunately, I’ve seen all too often that same anger and frustration seep over into our interactions with patients and attempts to educate. Whether it be an in-person patient visit, a legitimate YouTube video promoting good medical research, or a medical education podcast where those same patients are likely listening, I’ve seen attempts to educate range from displays of educational superiority to outright calling people stupid.

The end result is the same: It does not work. All that it accomplishes is that the patient will further dig their heels in. Their resistance to understanding the science and getting vaccinated only grows, and they become even more vocal in their resistance.

I don’t claim to be perfect regarding this. I know I’ve had my moments I could have handled far better.

On the one hand, we figuratively say, “Shut up and just listen to me, I’m the one who has the education to speak on this,” and lament to each other, wondering how they don’t understand. On the other hand, most patients don’t have the same education as we do, so how can we expect them to understand and know that what they read or see is junk science? We essentially criticize patients for lack of understanding when most are not in that position, to begin with. As health care providers, we can have unrealistic expectations of our patients.

The title of my piece intimates we need to understand our patients. Let me be clear: I’m not saying we need to be open-minded about unfounded scientific claims regarding COVID or vaccines patients have and try to understand their point of view.

We need to be vigilant about understanding that most patients are at a disadvantage not just in regard to overall scientific and medical knowledge but also about properly critiquing articles, research, and studies. You and I indeed have the benefit of our education. Not just the biology and chemistry that underlies our additional medication education but the benefit of how to recognize good from bad research.

We know that data from a large double-blind, randomized controlled study far outweighs outcomes from a retrospective study with a small patient cohort. Most of our patients know none of this, yet there is this underlying expectation within ourselves that when we discuss studies, they understand everything coming out of our mouths even though their eyes glaze over when we actually say, “Double-blind, randomized controlled study.”

Add to it, patients are bombarded by bad research and opinions from numerous directions while we essentially get our information from one arena. While there are many different journals and sources behind our continuing medical education, they are all based on peer-reviewed, evidence-based medicine.

Most of our patients don’t have easy access to the same resources we do, and even if they did, many likely would not understand the articles heavy in medical and scientific jargon. Instead, they are bombarded with misleading and inaccurate opinions from local news and 24-hour “news” channels, predatory non-peer-reviewed journals, anti-vaccine YouTube videos crafted to look medically professional but not based on any evidence, questionable opinions and advice from TV medical talk shows, and biased opinions from fringe politicians and religions.

Given all that, the real question is, how aren’t more patients refusing vaccination, treatment recommendations, and our answers to their medical questions? I would wager that if we had not pursued science-based careers, a good percentage of us would fall into the same trap as our patients.

Another aspect we need to understand is that a lot of anti-vaccine sentiments and refusals to believe science is based in some kind of fear. Whether instigated by a third party or not, these patients have some sort of fear. It could be fear of not being in control, fear of needles, fear of the government, fear of not being able to understand the science, fear of side effects (which is a legitimate issue to question), and their refusal to get vaccinated or follow recommendations is their way of exerting their own control of the situation.

I should go on a partial tangent and say that it is not a criticism of their intelligence for those who don’t understand the medicine and science. I do not doubt that many of those who are anti-science are smart people who just have not had the same education and experience that we have. As such, in addition to easier access, it may be easier for them to understand the conspiracy theory that you and I lament. Understanding, even if incorrect, belays one’s fears.

Finally, paraphrasing Col Henry Blake to Capt. BF “Hawkeye” Pierce with a large degree of literary license, “Rule number one, many patients don’t listen to health care providers. Rule number two, health care providers can’t change rule number one.”

Simply put, we have to understand and accept that no matter how empathetic we are or how well we explain things, there will always be those patients who will never heed our recommendations.

This really isn’t groundbreaking per se. I’m sure we have already realized this over the years with patients who refuse to quit smoking or sign out against medical advice.

Still, this has become far more prominent in the age of COVID. Even more so, now we have to know when to let go and pick our battles.

Furthermore, we should remember to practice self-care, both physical and mental. In my humble opinion, I think the latter is far more overlooked. So, in addition to eating better and exercising, don’t forget your mental health. Take that day trip, unplug from the internet, read for pleasure, return to a hobby and consider having a therapist.

Personally, I can attest that having a therapist has been immeasurably valuable this past year. Though I really should take my own advice on unplugging from technology.

So what is the answer? Like most things in life, it’s not a one-size-fits-all. The starting point is to do our best to approach discussing COVID and vaccination with the appropriate type of empathy and understanding.

To understand that our patients don’t have access to the same level of data and research that we do, and even if they did, they might not understand it. To understand, they likely have fears underlying their reticence.

Understand you may not ever reach them, or you may need to back off for a short time. This can all be done without acknowledging their conspiracy theory or misleading talking point from 24-hour cable news is a legitimate point of view.

While admittedly anecdotal, I’ve reached more anti-vaxxers starting with empathy and understanding than with a “that’s the way it is, that’s what the data shows” mentality. Even if I don’t reach them, I’m a lot less stressed. Last but not least, take care of yourselves and each other.

Kenneth Szwak is a physician assistant.

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