National Immunization Awareness Month got me thinking about vaccines, but probably not in the way you might expect. I have never been anti-vaccine. In fact, vaccines are very personal to me.
My father had polio. I spent my entire life watching the effects it had on him and thinking about how different his life might have been if the polio vaccine had been available before he contracted the disease. It became available just a year later. I believe in safe, effective vaccines, and I have seen firsthand what a vaccine-preventable disease can do.
But I also believe we have a problem in medicine right now, and it is bigger than vaccines. We have a trust problem, and I think all of us in health care need to pay attention to it.
As clinicians, we are taught to practice evidence-based medicine. We look at the research, weigh benefits and risks, use our clinical experience, and apply that information to the individual patient in front of us. But what happens when our patients no longer trust the evidence? What happens when, frankly, some clinicians are also struggling with questions about what information they can trust?
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Years ago, a physician friend of mine worked in pharmaceutical research. She told me she ultimately left after being asked to “fudge the results” to make a drug look better. She couldn’t do it, so she left.
That is one person’s experience, and I certainly do not believe it means pharmaceutical research as a whole is dishonest. But I have never forgotten that conversation. Research is conducted by human beings, often within systems where there are financial pressures, career pressures, and conflicts of interest. As clinicians, we cannot turn off our critical thinking simply because something has been published or labeled “evidence-based.”
The COVID years made this even more complicated. Medicine became intertwined with politics, public policy, social media, mandates, rapidly changing recommendations, and very strong opinions. Some of that was unavoidable because we were dealing with a new disease and evolving evidence. But some of what happened damaged trust.
Watching Dr. Anthony Fauci repeatedly invoke the Fifth Amendment during a Senate hearing this summer bothered me. A lot. I understand that invoking the Fifth Amendment is a constitutional right and does not prove wrongdoing. Still, it was difficult to watch someone who had been one of the most recognizable voices of the pandemic decline to answer question after question.
Whatever your political views, moments like that affect how people see medicine and public health. They affect how patients view government agencies, researchers, pharmaceutical companies, and the clinicians sitting across from them in the exam room. We are seeing the consequences of that loss of trust now.
A patient may sit across from an experienced clinician who has spent decades studying medicine, evaluating research, caring for patients, and keeping up with changing guidelines. Yet that same patient may place more trust in someone they follow on Instagram or TikTok who has no clinical training at all. That is frustrating, but simply telling patients that they are wrong or that they need to “trust the science” is not going to fix it.
Evidence-based medicine has never meant blindly accepting every study, guideline, or recommendation. It means looking at the best available evidence, combining it with clinical expertise, and applying it thoughtfully to the individual patient. Critical thinking is not the enemy of evidence-based medicine. It is essential to it.
We should ask questions about research. Who funded the study? Who was included? What outcomes were measured? Were the findings replicated? What were the absolute benefits and risks? How strong is the evidence, and where are the uncertainties? Asking those questions is not anti-science. It is part of practicing good science and good medicine.
At the same time, questioning evidence does not mean dismissing good evidence because we do not like the conclusion. There is a difference between healthy skepticism and deciding that every researcher, institution, pharmaceutical company, or public health agency is corrupt. That middle ground is where clinicians need to live.
We have to be willing to tell patients what we know, what we do not know, and why we recommend what we recommend. We also need to acknowledge when evidence changes, when uncertainty exists, and when a patient has a reasonable question. Trust is not rebuilt by demanding it. It is rebuilt by being worthy of it.
I think about my father and what a safe and effective polio vaccine could have meant for his life. That is exactly why I do not want us to lose confidence in vaccines, science, or medicine. But preserving that confidence requires more than telling people to trust us.
Patients are going to keep asking questions, and they should. Our job is to understand the evidence, question it appropriately, recognize its limitations, and explain it honestly. If we do not do that well, someone on TikTok or Instagram will gladly fill the void, and we all deserve better than that.
Lynn McComas is the chief nursing officer at AMOpportunities and the founder of PreceptorLink. She is a recognized expert in precepting nurse practitioners and advanced practice provider students and has been matching preceptors since 2014. With over two decades in primary care, McComas has served as a coach, advisor, mentor, and preceptor for countless healthcare professionals, including NPs, nurses, and medical assistants. She co-founded a successful skills and procedures business and speaks nationwide on NP-related issues.
McComas is also a regular contributor on LinkedIn, KevinMD, Facebook, YouTube, Instagram @preceptorlink, X @LynnMcComas, and her blog, where she addresses the growing NP and PA professions and the urgent need for preceptor sites.
Her unique perspective, shaped by her business, clinical, and educational experiences, positions her as a key voice in tackling preceptor shortages. McComas is committed to driving change through a paradigm shift in NP education, reducing barriers, offering preceptor incentives, and advocating for reforms within the profession.
