I wish it didn’t require a cancer diagnosis to trust me [PODCAST]

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“The medical profession hasn’t changed.

Our credibility hasn’t changed.

Our commitment to care for you – to adore you, to grieve your diagnosis and what it means for you and your family – hasn’t changed.

Our advice hasn’t changed.

I’m grateful for your trust in me.

I wish it didn’t require a cancer diagnosis to win it.”

Cynthia Cooper is a hospitalist.

She shares her story and discusses her KevinMD article, “I’m grateful for your trust in me. I wish it didn’t require a cancer diagnosis to win it.”

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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 Cynthia Cooper. She is a hospitalist, and she wrote the KevinMD article “I’m grateful for your trust in me. I wish it didn’t require a cancer diagnosis to win it.” Cynthia, welcome to the show.

Cynthia Cooper: Thank you so much, and so happy to be here.

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

Cynthia Cooper: Sure. Well, my journey starts in Pittsburgh, Pennsylvania. I grew up there, and I’m the second of two daughters. I came up to Boston for Wellesley College for undergrad, spent a little time in Chicago as a health care consultant, and then came to Harvard Medical School for medical school, came to Mass General Hospital, and have been there pretty much ever since.

I’m actually trained as a nephrologist. I did a fellowship in nephrology and still love teaching about electrolytes and about kidney failure and so on, but I have joined this academic hospitalist group, and I have really found a home among a group of wonderful educators.

Kevin Pho: So like you said, you’ve been a hospitalist for the last few years now. Tell me about the evolution of the profession. What’s changed over the last few years regarding hospital medicine?

Cynthia Cooper: You know, I think there are things that I’ve seen change. Well, definitely my group hasn’t changed as much. You’ve always been focused on the care of the patients that are on the academic services. There’s definitely been an explosion of what it means to be a hospitalist, in terms of having nurse practitioners and also having physician extenders as part of the group.

I think that hospital medicine was an unknown profession to many residents who were coming out of residency, say, 15 years ago, and it has become not only just a wayward stop on the way to a fellowship but something that can actually be a career, and where people can find fellowship and scholarship and a real community within the hospitalists.

Kevin Pho: I’m seeing advanced practice practitioners also, in my hospital program, increasingly be involved with hospitalist teams. So can you comment on that? Tell me how that has changed or evolved hospitalist care, the involvement of advanced practice practitioners.

Cynthia Cooper: Yeah, you know, and I’ll say right from the beginning, I don’t really work with them myself, so my answer is somewhat limited because of the kind of hospitalist that I am, that is, an academic hospitalist that only deals with residents. So in many ways, the residents are sometimes my extenders in my practice as a hospitalist. But I do know from those colleagues that I work with that they have found a sense of community with people who have come from different backgrounds in terms of the way that we take care of patients. But unfortunately, I’m not someone who actually works with those professionals myself.

Kevin Pho: And from working with residents all these years, have you noticed an evolution or change in the medical residents I’ve been working with over the years?

Cynthia Cooper: Oh, they’re still the same bright, incredible people that they’ve always been. I think that I am incredibly lucky to work with some of the best residents in the whole country at Mass General. As I said, again, their interest in me as a hospitalist, in terms of my career path, has definitely evolved over the years, and people are much more likely to want to become me than they were, say, 10 years ago.

Kevin Pho: Wonderful. So let’s transition to KevinMD, the article that you wrote. It’s titled “I’m grateful for your trust in me. I wish it didn’t require a cancer diagnosis to win it.” 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?

Cynthia Cooper: Sure. So the story is one of this wonderful man that I met who was in terrible circumstances. He was 60-something years old, the same age as my husband, and he came into the hospital with evidence of having widespread cancer. It was, I mean, his abdomen was in his thorax. It actually ended up being a cancer of unknown primary.

One of the first things that happened when I walked into the room was he said to me, “I’m not getting a COVID vaccine,” and he was very, very adamant that that was the case. I spent a lot of time with him, sitting at his bedside, sort of listening to the different reasons why he didn’t want to have a COVID vaccine. It was interesting to me, and somewhat shocking to me, the disparate pieces of information that were being pulled together as to why the COVID vaccine was somehow bad for him. It ranged from President Biden being a bad president, to people coming over the border, to a scandal somehow related to Pfizer. I mean, it was so much propaganda that didn’t make any sense to me.

What really ended up happening is that it was just the time that I spent listening to him and showing him how much I cared about him, and how much I was concerned that if he did get COVID, it would be the end of him, at a time that he was facing this very serious, life-threatening illness, that made a difference to him.

What I remember most about him was that he had been this successful salesman who had done very, very well in 2020. It had actually been one of the most successful years of his life. He had spent the whole year at his summer home. He hadn’t had to go in to any sort of family meetings that he didn’t want to. So his perception of what 2020 was like was so different from what mine was like, where it was one of death and illness and terror.

When I finally convinced him that he should get the COVID vaccine, he said to me, “You know what? You have to learn the first rule of sales, Dr. Cooper.” And I was like, “Well, what’s that?” He said, “Well, once you’ve sealed the deal, you need to shut up and get out of the room.” And I took that to heart, and did, and immediately left the room, and we went and got a Moderna vaccine. He was accepting of it, and then later on, he let me know when he got his second vaccine, and he continues to this day to let me know how he’s doing.

Kevin Pho: So when you talk to patients who are unvaccinated in a hospital, what’s your general approach?

Cynthia Cooper: Sure. I’d say, for me, it showed the importance of listening to patients, kind of meeting them where they are, and finding a sense of connection with them. We connected over multiple different things, including our families and our relationships, and that connection is what allowed me to get to the place where he actually could make the right decision for himself.

Kevin Pho: Do you think, with that particular patient, you told him your story? Was there anything specific that you said that resonated with him that made him eventually get the Moderna vaccine?

Cynthia Cooper: I think it was just that it was clear to him how much I cared about him. I came and visited him every day, and we would talk about not just the vaccine, of course, and not just his cancer diagnosis, but about his business, and how he had dropped out of high school and had dropped out of college and had started his own business. I really got to know him as a person, and I think it was that curiosity that I had about him that made him feel a sense of trust in me, and that I really was looking out for his best interests.

Kevin Pho: I think it’s important to share success stories like these, because there’s a perception, especially when I talk to other physicians on this podcast and physicians who write on my blog, that once people decide not to get the COVID vaccine, it’s very difficult to persuade them. So I think it’s important to share stories where physicians are successful in convincing patients. In general, in the hospital, how often are you successful in getting patients to change their minds about the vaccines?

Cynthia Cooper: You know, I think that being in the hospital is actually a very critical moment, where people are facing their mortality, as acutely as my patient was, or patients who were somewhat less sick. But I think there’s always that opportunity to be able to have a human connection, in which they feel that you, their doctor, Dr. Cooper specifically, care about them and are wanting them to make the right decision. And I think that the more time that we’re able to make those connections, the more successful we’ll be.

Kevin Pho: For those hospitalized patients with COVID in a hospital, of course, the majority of them tend to be unvaccinated. Do you sense any regret from these patients when you talk to them about not getting the vaccine?

Cynthia Cooper: I have had patients who have expressed regret about not getting the vaccine, absolutely. I’ve been off service now for the last couple of weeks. I’m going back on service on Wednesday. My expectation is that, of the percentage of patients that I’m going to see in the hospital who are sick with COVID, who are unvaccinated, that’s going to be something that they are going to express as a sense of regret. I’ve heard many times from colleagues of mine talking about patients who say that they just never realized that it could be so bad, that they could be so ill.

Kevin Pho: We’re talking to Cynthia Cooper. She’s a hospitalist, and she wrote the KevinMD article “I’m grateful for your trust in me. I wish it didn’t require a cancer diagnosis to win it.” Cynthia, what kind of tips and advice can you give to other physicians in terms of talking to patients, in terms of convincing them to get the vaccine? And when you say that you want to sit down and get to know patients, give some examples. What are some of the things that you say in order to build that connection with patients, to better convince them, hopefully, to get the vaccine?

Cynthia Cooper: Well, I mean, not even just about getting the vaccine. One of my biggest things for any patient is trying to get to know them as a person as best as I possibly can. And you made a point of saying “sitting down,” and I think that that’s one thing that is incredibly important to any sort of connection: finding a way of showing that you are slowing down, that you’re wanting to spend time, that you actually care about who this person was before they came into the hospital.

A passion project of mine, which is a bit different from your question, is trying to get patients and their families to bring photos of what the patients looked like before they came into the hospital, into the hospital, as a way of better being able to have a connection between who they were before they came and who they are, dressed in a johnny, so sick and so nondescript from all the other patients that are in the hospital. To be able to see them with their family, to be able to see them with their loved ones, I think makes a big difference. And I think just asking that question, to be able to see photos of someone before they got ill, is one way that I build a bridge with the patients that I take care of.

Kevin Pho: So by the time this podcast publishes, we’re going to be in the midst of the Omicron variant. Now, for those podcast listeners who are listening to you and are on the fence about getting the vaccine, can you paint a picture of what it’s like to be in the hospital?

Cynthia Cooper: Oh, God, it’s the worst thing. It’s the worst thing. You are in a room by yourself. You are isolated away. Everyone who comes in to you is fully gowned, fully masked, this will be years, and so on. You feel horrible. As far as I can tell, for the patients who have COVID, there’s a sense of a cough that just will never quit, a sense of breathlessness that never gets any better, a sense of restlessness in terms of not being able to sleep or find a comfortable position. And in that setting, too, you are both afraid and lonely, and you can’t see your family members, because no one can come in and see you.

I think that COVID is one of the most depersonalizing, dehumanizing illnesses that we have, and it must be incredibly frightening for anybody who has it to be sick in the hospital with this illness.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Cynthia Cooper: Take-home messages. Well, of course, always listen to your patients. Sit down. Find a way of finding a human connection with them, the best way that you possibly can. And enjoy the privilege that you have of being a physician in a hospital, taking care of patients that sometimes you would never have met in a million years in your life. Those patients get a chance to sort of become part of your life story, and you become a part of theirs. It’s an incredible privilege.

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

Cynthia Cooper: Sure. Thank you so much for having me. I appreciate it.

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