It is that time of the year again. The warm days of summer are long gone, it is getting colder every day, the busy holiday season is right around the corner. We are spending less time outdoors and more time with indoor activities in crowded spaces that crawl with germs. Holiday cheer will also bring the flu season. With that, once again you will have a lot of patients whom you will be trying to convince to get a flu shot, a vaccine that could potentially save their lives. For this, you will be battling misconceptions, misbeliefs, ignorance and prejudice against the flu vaccine. You will become frustrated, angry, bitter and at times feel defeated, no matter how hard you try.
The 2017-2018 influenza season was one of the deadliest in the recent history of the United States. The flu is a vaccine-preventable illness, although the vaccine is not always a good match every year. As frustrating as it might be to deal with the pushback from your patients (sometimes even from staff), advocating for your patients to get the flu vaccine is a noble battle worth fighting for.
The patients that refuse the flu vaccine for the most part make similar excuses or arguments and bring up common points. I will write about these points and how I typically respond to them in simple terms as an infectious disease specialist. I can say that a group of patients will still refuse the vaccine no matter what I do. I don't take it personally, just move on to the next patient. I hope to save another starfish in the vast ocean.
The conversation starts with me poking the beehive: "Would you like to get your flu vaccine today?"
"Naaah, I don't believe in the flu vaccine, doc." This is how the conversation would go:
"Oh really? I get my vaccine every year…You know, people cough and sneeze, and they don't even cover their mouths…You get exposed to all these germs in the air just by breathing." (Eyes open wide, easy to see some budding interest in them)
"I know the vaccine is never 100% protective but I would get all the protection I could get…" (I certainly have the attention at this point…Sometimes even a vigorous nod. I might get interrupted somewhere around here:)
"But flu shot gives you the flu!" (If I had a dollar for each time I heard this line…)
"It is not possible for flu shot to give you the flu because the flu vaccines either have the killed virus or they have only tiny parts of the virus to introduce to your body's immune system so you can develop the ammunition against the virus. So when the active live virus actually enters your body, you can fight it." (Attention is usually still maintained at this point)
"I/my cousin/mom/dad/friend/neighbor got the flu shot x years ago and got sick after getting the flu vaccine x years ago. So I never get the vaccine. I don't want to get sick"
"You know, it is funny you mention that, because I was just going to talk about this. I sometimes get sick after getting the flu vaccine too!" (What??? Eyes even wider now.) "It takes a couple of weeks after getting the flu vaccine for your body to develop the defense to fight with the flu. So let's say, if someone coughs or sneezes next to you few days
after you get the flu vaccine, you will not be protected yet and you can get sick…" (Light bulb goes on, the cogwheels of the brain get working.)
"But I never get the flu, I don't need the flu vaccine"
"It is a good thing that you have not had the flu so far but there is no guarantee that you won't get it this year. And many people think that flu is a minor illness but every year thousands of people die from the flu and its complications. Besides, even if it may be a minor illness for you, your newborn baby/elderly mom/sick family member (or your patient!!) may get very sick from flu and develop complications. By getting the vaccine yourself, you can also protect your loved ones" (This always brings the attention right back)
"Will it hurt?" (This signifies the beginning of acceptance…At this point, they can see the flu vaccine being administered to them in their minds. It is always a good sign.)
"You may experience some pain in your arm, generalized aches or pains or some low-grade fevers on the first day but this would go away fairly quickly. You can take some Tylenol, drink fluids and rest."
This is my usual spiel that evolved over the years and I have rehearsed it countless times with hundreds of patients. I found this to be quite effective as the arguments are very simply worded and are based on facts. What makes your arguments more believable is if you truly believe in receiving the flu vaccine yourself. Your patients will always respect, listen and seriously consider the advice of a passionate advocate. And don't forget to get your flu vaccine, too!
Gul Madison, MD, is an Infectious Disease specialist in Philadelphia. She is a 2018–19 Doximity Author.
