Medical students occupy a unique position on the spectrum between patient and experienced physician. Because of that, they can effectively discuss influenza vaccination with patients, family and friends in both formal and informal settings, using their growing expertise to bridge gaps and help change minds.
And though the flu season is underway, it’s not too late to think through those important conversations and develop a plan of how you’ll talk about flu shots everywhere from the Thanksgiving dinner table to clinical rotations.
Medical students “might be the one [health professional] where people are willing to sit and listen” to you, said Erica Kaufman West, MD. She is the director of infectious diseases at the AMA and presented on the topic at the AMA Advocacy in Action Workshop in October.
“You're also going to be looked at by family, especially nonmedical family members, as somebody who has knowledge and somebody who's safe” to share concerns or questions with, Dr. Kaufman West said.
Annual influenza vaccination is recommended for everyone 6 months and older who does not have a contraindication, and the AMA is strongly urging vaccination.
“Last year’s flu season was one of the worst in the U.S. in 15 years, and the statistics speak volumes. Fewer than half of all Americans received a flu vaccine last year, resulting in more than 620,000 hospitalizations and 27,000 deaths related to flu illness,” said AMA President Bobby Mukkamala, MD. “We cannot afford to repeat this pattern.”
Ideally, people should be vaccinated in September or October, but physicians and infectious disease experts say vaccination is helpful throughout the season while flu viruses are circulating. So, when medical students encounter the topic, they need to be prepared.
“That is the burden on the medical student, knowing that when you go home or when you visit people, you will be looked at as a source of information,” Dr. Kaufman West said. “You need to then have the knowledge and be ready for that.”
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Having a conversation that works
First things first: Do your reading. Prepare yourself with information about topics of general interest related to the influenza vaccine including its efficacy as well as flu symptoms, transmission, mortality and hospitalization rates, Dr. Kaufman West advised. The AMA provides resources about the flu to get you started and has published infographics to help patients (PDF) and physicians (PDF) cut through vaccine confusion and have open, honest conversations with each other.
“Arming yourself with a few numbers can be helpful. And then after that, it becomes helpful to understand what the actual concerns are going to be,” she said.
Then, take the mathematical sting out of the conversation. Most people are not adept at statistics or have the deep interest in science that medical students have. Dr. Kaufman West suggested keeping the numbers simple and focusing on people who are helped by an influenza vaccination—saying something like: “If 100 people get the vaccine, 40 of them aren't going to get very sick.”
If it looks like the person doesn’t understand the information, she said, “they probably don't.” Try to back up and explain again. But if they ask questions that make it clear they want more detail, feel free to take the conversation up a notch.
“The whole point is to get the information across in a way that makes sense to that person,” she said.
Learn more with the AMA about the eight things doctors wish patients knew about flu vaccines.
Don’t steel yourself for a fight
Get yourself in the right headspace to talk about the value of influenza vaccination, and don’t let public discourse on the topic make you preemptively defensive.
“Our mindset affects how we come off with these conversations,” said Dr. Kaufman West, who counsels that antagonism from social media influencers, politicians and media figures over vaccinations may lead us to believe that these discussions will be confrontational. But often, that’s not true.
“It's easy to walk into a vaccine conversation with the anticipation that you're going to get pushback and with the anticipation that this is going to be a fight. But for most people, it's not,” she said, adding that anticipating problems may wind up creating them. “If you think that this is going to be a struggle, then you already come at it with your anxiety high and you're going to maybe use language that's a little bit more forceful and a little bit pushier than you might otherwise.”
Approaching yearly flu shots in the same way physicians do mammograms or regular checkups can defuse tension.
“Whether you're talking to a patient or a family member or whoever, it's important to make vaccination the default way that we do things,” she said. “Saying, ‘We’ve got the flu shot here for you today,’ rather than, ‘Do you want the flu shot?’ normalizes vaccination.”
The difference between declining and refusing
If a patient, friend or family member says they don’t want an influenza vaccine, politely request more information.
“It's totally fine for us to say: ‘Can I ask why?’ It's nonthreatening. You're asking for permission to even ask the question,” Dr. Kaufman West said, adding that there are many reasons why someone might decline. “Sometimes it's because they don't have time to wait or they have a big test tomorrow and they don't want to have a headache. There are a lot of reasons that are not actual refusal.”
Read about the six reasons patients avoid flu vaccination.
Misinformation vs. disinformation
If it is a matter of true vaccine refusal, Dr. Kaufman West said, there are two different ways that people arrive at incorrect or unproven beliefs: misinformation and disinformation. It is important not only to know that, but also to plan a different response to both. Someone led by misinformation, coming from anecdotes or rumors, may be more likely to listen to and be persuaded by good evidence.
“Misinformation is: ‘Oh, this flu shot is going to give me the flu.’ That's something that you can easily correct with scientific information,” she said. “But if it starts to go down a different route where it's actual disinformation, that makes it harder.”
An example of disinformation would be when someone asserts that there are microchips or toxic ingredients in the vaccine. Dr. Kaufman West said that in a case of disinformation, start by listening.
“Sometimes you just have to listen to that person and let them talk through whatever theory they have ingested,” she said. “Then it's almost starting from square one to say ... ‘Thank you for sharing that with me.”
Then, you might detail what your personal experience has been, saying something factual but nonjudgmental like: “I have not read anything in medical journals about microchips being implanted. I don't think that's something that is going on.”
If the conversation begins to derail, end it without rancor.
“For people who are really in that disinformation echo chamber, the best thing you can do is just listen and not be one of those doctors who writes them off,” Dr. Kaufman West said. “Maybe you can just be a friendly face in the medical sphere, which they might not see often, and then you can, hopefully, be the first step in other people being able to reach that person.”
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Don’t take a “no” to heart
Medical students should also understand that they do not need to persuade each person they speak with about flu vaccination to get vaccinated, Dr. Kaufman West said. Their role is to properly explain the benefits of vaccination and to make a recommendation.
“You've done your part and now it's up to the next doctor or the next medical student or the next resident to do their part,” she said. “And if we all do our part, then hopefully—and it might not be this flu season, it might be two flu seasons down the way—we can get to that person and finally turn their vision a little bit to evidence-based medicine,” she said. “But if we write them off and don't engage with that person at all, then we have lost them.”
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