PODCAST: Caring for the Unapologetically Unvaccinated

We share two conversations about navigating the waters of interacting with unvaccinated COVID patients. Brit Long, MD and Jose Pacheco, RN are thoughtful healthcare providers with somewhat different approaches. The common thread is that both are intentional and compassionate.

Guest bios: 

Brit Long is an assistant professor of emergency medicine in San Antonio, Texas and Editor-in-Chief of Clinical Content at emcdocs.net. He is one of the most published authors in the field of emergency medicine. Brit is working in a unique environment where he’s running what is in effect a COVID emergency department in an underserved area with an incredibly high unvaccinated rate.

Jose Pacheco is an emergency department nurse who is a local legend for his kind personality and fully engaged approach to caring for patients. He is not just a legend among healthcare providers, but frankly, among the community.

We discuss:
 
Brit’s mental processes when he enters the room of a patient with COVID pneumonia who is unapologetically unvaccinated [05:15];
  • Brit doesn’t let his thoughts or biases weigh in to how he will care for the patient. He took an oath to care for everyone no matter what the circumstances, and he objectively does his best, giving 100% effort all the time.
 
How Brit discusses the importance of vaccination with unvaccinated patients [05:43];
  • Brit takes a compassionate and non-judgmental approach, using listening as his strategy for seeking to understand.
  • He simply asks, “Would you be willing to talk to me about getting a vaccine at some point?” This shows that he’s respecting their opinions and increases their willingness to discuss it. With this approach, 20% of the time patients show interest in getting the vaccine afterwards.
 
The impact of one’s belief system on vaccine decision-making [07:15];
  • Rob and Brit believe in science. Scientific evidence that is peer reviewed, reproducible, and has fail-safes to ensure that what people are saying is correct, then they believe it is true.
  • We should seek to understand what people who choose not to get vaccinated believe about the vaccine. Asking, “What are your concerns about the vaccine?”, you find that people have perspectives, fears, and concerns that you would never have anticipated.
  • The book, Humble Inquiry: The Gentle Art of Asking Instead of Telling, brings up one of the fundamental problems of our culture: we do not have a real sense of inquiry into the beliefs of others. Instead, we bludgeon with our opinions and beliefs and push others into submission, claiming that we are right and they are wrong.
 
“We just need to address the person’s concerns. We’re not trying to label them as anything. We’re trying to understand their fears and answer questions. By doing this, people are more open to hearing what you have to say.”
 
The fact that personal stories (and not scientific evidence) are what many who aren’t able to critically appraise literature rely upon to make decisions [15:25];
  • People believe the stories. When they hear about an adverse event after a COVID vaccine, they conclude that vaccination is a bad idea. The truth is that any vaccine is going to cause problems for a small subset of people.
 
Framing the COVID vaccine as an anti-death vaccine [16:45];
  • The vaccine is not going to keep you from getting infected, but it will keep you from dying with incredible efficacy.
 
Handling post-shift frustration [19:30];
  • We are now in the long haul of the COVID pandemic and most healthcare providers leave shifts feeling depleted.
  • For Brit, it helps to decompress by asking a family member to listen to him for 2-5 minutes as he gets things off of his chest. He specifically requests that they not give feedback or speak at all.
 
The importance of celebrating the success when a vaccine hesitant person agrees to vaccination after you discuss its merits [22:45];
  • Celebrate these moments. And thank the patient for deciding to make this huge impact on the healthcare system.
 
Jose’s plea to fellow healthcare providers [25:00];
  • “I hope that you guys hang in there. This is not the time to quit. I believe there is an endpoint to this insanity. At the end of this, we’ll look back and feel proud that we stayed. If you’ve been in this game and you’ve been fighting this fight, you understand COVID more than anyone else coming into the game. So please hang in.”
 
What makes the COVID situation more difficult than others we encounter in the ED [27:40];
  • It’s not that it’s more work. The work is the same. It’s just more things you have to do regarding work.
 
“Picture a track. You go to work and you’re running this track. But because of COVID, you’re not just running the track, there are hurdles. And as things develop and we learn more, we’re putting up more hurdles to protect the patient and ourselves. Everybody gets frustrated with these hurdles, of course. But if you get used to the hurdles, then you’ll be strong enough to just jump over them as, you know, we do.”
 
Why Jose is referred to not only as the Drunk Whisperer (see Stimulus episode 1), but also the COVID whisperer [28:30];
  • Jose goes to each shift telling himself he’s there for many reasons. But one of the biggest is to help those that he rubs elbows with be in a better mood. “I am there to bring joy and light and a little bit of fun to the environment. But by the end of the shift, I am depleted.”
  • On occasion, Jose has taken over the care of unvaccinated patients when their personalities clashed with the primary nurse. He disarms patients by informing them that he doesn’t care why they chose not to get vaccinated. He doesn’t judge them. His sole purpose is to get them better, and he does it with love.
 
Many unvaccinated patients think they’ve done their due diligence [40:20];
  • Most lay people are not able to interpret medical research and data. So they rely on social media and anecdotes to guide their thinking. “You can’t be upset because in their mind they are doing their due diligence. They are doing what they believe is right.”
 
“When you are in these situations, it’s time to maintain your compassion and to maintain your intent of caring for people. You put your shields up and circle the wagons. My team and I are sacrosanct. We are a tight, special unit.”
 
The root and seat of compassion — wishing that all patients are well, vaccinated or not [46:15];
  • While some might think that a sick unvaccinated COVID patient did this to themselves, we need to remind ourselves that they thought they were doing the right thing.
  • Just as you wouldn’t get mad at an Alzheimer’s patient who urinated on the ground or a smoker who had an MI, why get angry at someone with COVID who chose not to get vaccinated?
 
“Do what you took an oath to do. Approach everybody as though their situation at the present moment is not necessarily their fault, it’s just the fight that they’re fighting and the information they’re being fed. Instead of looking at the patient as the issue, just look at the issue at hand. We need to stop seeing a divide here.”

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