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My patients will tell you that I am pretty laissez faire as doctors go. I have enough respect for people's ability to make good decisions about their own lives and enough humility about the limits of medical certainty to support my patients' choices- even when they choose not to follow my recommendations. When a patient says ‘no thanks' to a cholesterol lowering medication or skips a mammogram I try to understand their reasoning, supply information about the possible negative consequences of the decision but I don't berate them. My feeling is that if I did berate them it would only injure our rapport and make them less likely to visit me again or confide in me and that - more than any missed test or untaken prescription -would be harmful to their health.
Lately, though, about one issue in particular, I've been getting a little more, shall I say...assertive. A recent National Foundation for Infectious Diseases survey estimated that half of eligible Americans do not intend to get flu shots this year - a year when the emergence of H1N1 or swine flu threatens to make this the worst flu epidemic in terms of incidence, hospitalizations, and deaths in half a century. Granted the roll out of H1N1 vaccine has been slow and even regular seasonal flu shots are in short supply in some areas (though both of these issues will be rectified in coming weeks) so some people actually haven't had the chance to turn down the vaccine. But, if my practice is any indication, they will. I have spent much office time lately having conversations about the vaccines with skeptical patients and finding myself becoming-uncharacteristically for me - more and more directive.
For example, Alice (as I'll call her), a sixty year old elementary school teacher, never had a seasonal flu shot and didn't want one this year. I asked why, especially since in her job she is exposed to young children at high risk for complications of flu. I thought I could clear up a simple misconception about the vaccine (the most common one is that it "gives you the flu") but her objections (and my counter objections) continued on one after another: "But I've never had the flu" You're lucky; "But my students will all get shots anyway" They won't; "But they say this year they rushed to make the vaccine too fast" Who's "they?"
I made my final appeal: "Look," I said, a tad exasperated, "You're free to make any choice you want but please make it based on real information!" Alice remained unmoved and I left the exam room... embarrassed. I was taught that doctors never should lose their cool, their equanimity and though you wouldn't have called my words angry or intemperate my impatience surely showed.
A few minutes later my assistant poked her head into my office and said,"That woman you just saw? Alice? She changed her mind. She'd like a flu shot."
I like my laissez faire style better, and my patients undoubtedly do, too. But extraordinary times often call for extraordinary-or even pushy- means.
