Thursday, February 17, 2011

The high stakes of those conversations about flu shots

The first patient on the residents' schedule today was a child febrile to 102 F with cough and malaise.  The clinical picture strongly suggested influenza infection, especially in the setting of spiking flu rates in our area.  The resident looked through the chart and found that the family declined influenza vaccination here last fall.

It is a story that I have heard so many times already in my career, and one that I fear I will continue to hear.  I spend the fall months imploring people to vaccinate themselves and their families.  I answer the same questions over and over again: "No, the flu shot cannot give you flu.  It's just bits and pieces of dead virus."  "Yes, the flu shot can make some people feel mildly ill for a day or two.  That's just your body's response to the vaccine doing its job." 

Then late winter arrives (last season's H1N1 pandemic notwithstanding), and we are confronted with the misery of our patients who suffer terribly from influenza.  And, honestly, at least for me, the compassion for these patients comes mingled with frustration.

I certainly understand why our patients are declining vaccination for influenza.  They are barraged by media messages that inconsistently fall on the side of science and reason.  Googling "influenza shot" brings plenty of reputable sites, but, also, several that trumpet anecdotal tales of woe blamed on the flu shot. Over 50% of healthcare workers don't get flu shots for themselves. (1)  No wonder patients doubt the safety and/or necessity of influenza vaccination.

My frustration arrives when patients seem more inclined to believe all of those messages over their family doctors.  Why doesn't the "MD" after my name carry more weight?  Why don't more people heed the repeated calls from a myriad of organizations for vaccination?  Has the public lost faith in our profession?

Meanwhile, my public health training reminds me to look at the bigger picture.  Tens of thousands of Americans will die from influenza and its complications this year. (2)  Those numbers remind me that the goal of regaining our patients' trust is not ultimately about us; it's about saving lives. I cannot succumb to frustration, lose patience with answering those questions, and give up my persuasive efforts. The stakes are too high.
 
I only wish that the consequences of that failed persuasion didn't include the suffering of a child from a potentially preventable illness.

(1) Mitchell D.  "Poor Flu Vaccination Rates Among Health Care Workers Imperil Patients, Colleagues."  AAFP News Now.  August 4, 2009.  http://www.aafp.org/online/en/home/publications/news/news-now/vaccine/20090804hc-workers.html  accessed 2-17-11.

(2) Because the spectrum of influenza is highly variable from season to season, annual death rates have varied greatly over the last 50 years.  The current estimate of the average deaths expected in one year is 25,000.  "Estimating Seasonal Influenza-Associated Deaths in the United States: CDC Study Confirms Variability of Flu."  http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm accessed 2-17-11.

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