On Speaking to Patients About Vaccines

I gave a presentation in business school about how to talk with patients about vaccines.  The intended audience was doctors who are struggling with their conversations with patients about vaccines.  I have included a brief transcript of my talk below.  To doctors, I hope you find this somewhat novel approach useful.

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Measles.  Influenza.  Chickenpox.  These diseases are very contagious, potentially fatal, but all are preventable with a simple vaccination.  Now I am not here to tell you about how effective vaccines are.  The research has been done extensively, the facts are all out there, and we are all aware of them.  So why is it that only a third of adults get their flu vaccines and only half of all children get their flu vaccines?  Obviously, the way we have been talking to our patients about vaccines is ineffective.  Today, I am going to tell you about a different way to talk to our patients about vaccines.

The medical community has been bombarding patients with facts, facts, and facts, but is it working?  Even though those facts are completely valid, there are still patients who do not believe them.  What we are missing is an emotional connection.

People don’t make decisions based on logic, but based on emotions.  That’s why telling patients about vaccine facts doesn’t work.  Make your facts come to life with a story.  Statistical numbers will come to life if you give each number a face, a name, a story.  In order to change patient behavior, we need an emotional connection.  Without a story, the facts don’t mean anything.

Does this mean we should neglect all the facts about vaccines?  No.  What I am saying is that for patients who do not believe in our facts, we have to use a different approach to connect with them.  You may say “But I don’t have any stories.”  There are actually a lot of stories about vaccines.  Let me give you an example of one story.

This is the story of Ayzlee McCarthy.  She is a very healthy 3-year old who lived in a small town in Iowa.  Like any other little girl, she loved Frozen.  She loved Dora the Explorer…Doc McStuffins.  She loved her “big girl bed”.  She was really proud that she just completed potty training.  As you can see from her photos, she has a big smile, an infectious excitement for life.  She had a wonderful Christmas with her family.  She spent the day after Christmas running around the house.  But on the 27^th, she became disoriented and was rushed to the hospital.  She was diagnosed with the flu.  On the 29^th, she woke up with labored breathing and racing heart.  Ayzlee breathed so hard that she told her mom, 'Mommy, I done.  I done…I so tired!”  Her mom is actually a respiratory therapist, and she remarked, “I’ve had elderly patients tell me those things before they pass, but not a 3-year-old and not my own child!”

The mom told Ayzlee that she loved her as the doctors intubated her.  Ayzlee’s heart stopped beating as the mom watched the procedure from the hallway.  They tried to revive her 3 times.  Her mom told the doctors “Keep doing it.”  By the time Ayzlee’s dad arrived, Ayzzlee still had a weak heart rate.  The parents went in and told their little girl they loved her one last time.  She died minutes later.  She was buried on New Year’s Day this year.

The story here is that flu kills very quickly.

The flu shot can save a life.  The measles shot can save a life.  Vaccines save lives.

What is a story that you can use to share with your patients?

I leave you today with this quote from an American writer and bestseller author.  He said, “When dealing with people, remember you are not dealing with creatures of logic, but creatures of emotion.”  By changing our own behavior toward our patients, I believe that it is possible to change their behavior.

Go ahead, tell a story.  A story will help them figure out what all these facts mean.

On Texas Medical Terms

Ever get confused with all the medical words your doctors use? This list of Texas medical terms and definitions will help. I do not have a problem with Texas. I have a problem with people using medical words wrong. This shows you how to use them right.

• artery = the study of paintings
• bacteria = back door to the cafeteria
• barium = what doctors do when patients die
• benign = the year after you be 8
• Cesarean section = a neighborhood in Rome
• cat scan = searching for kitty
• cauterize = made eye contact with her
• colic = a sheep dog
• coma = a punctuation mark
• D&C = where Washington is
• dilate = to live long
• enema = not a friend
• fester = quicker than someone else
• fibula = a small lie
• genital = a non-Jewish person
• G.I. series = world series of military baseball
• hangnail = what you hang your coat on
• impotent = distinguished, well-known
• labor pain = getting hurt at work
• medical staff = a doctor's cane
• morbid = a higher offer than I bid
• nitrates = cheaper than day rates
• node = I knew it
• outpatient = a person who has fainted
• Pap smear = a fatherhood test
• pelvis = second cousin to Elvis
• post-operative = a letter carrier
• recovery room = place to do upholstery
• rectum = almost killed him
• secretion = hiding something
• seizure = a Roman emperor
• tablet = a small table
• terminal illness = getting sick at the airport
• tumor = more than one
• urine = opposite of you're out
• varicose = nearby

On Christian Doctoring

On Christian Doctoring

What do you think of when you imagine a "Christian doctor"? Do you visualize a condemning pro-life activist? Do you think of someone withholding birth control from teenagers in an attempt to prevent promiscuity? Maybe you visualize a medical missionary in a third-world country. Well, I am none of the above but I am a Christian doctor. It has taken me a long time to understand what it means to be a Christian doctor. Since medical school, I have been a part of Christian Medical and Dental Association (CMDA), New York Medical College Christian Fellowship (NYMCCF), New Hope Fellowship Church (NHF), Morning Star New York Church (MSNY), First Baptist Church of San Francisco (FBCSF), City Presbyterian Church (CPC), Central Peninsula Church (another CPC), and Many Other Christian and Medical Groups With Short and Long Names and Abbreviations (MOCMGWSLNA). While these groups attempted to define "Christian doctor," I still had the same basic question:

If a non-Christian doctor can embrace Christian virtues e.g. love, compassion, patience, etc., what sets a Christian doctor apart?

I met a nice Christian man named Greg several years ago. I got to know him more recently as I became involved in his medical care. He has a terminal illness. While those surrounding him were saddened by the diagnosis, Greg seems to be in happy spirits. He is very knowledgeable of his advanced disease, but chose not to let that interfere with his daily life. He was still speaking at church, taking his son to the beach, and asking me out to lunch. As a doctor, it is always hard to have the end-of-life discussion with a patient. (Sometimes, I think it is more uncomfortable for the doctor than for the patient.) However, when I spoke to Greg about his wishes, it was very easy: he was certain that it was God's will for him to return to India. Other doctors, Greg himself, and I all had concerns about his physical state for traveling. However, Greg was able to see God's big picture for him beyond his illness. Soon, I began seeing it too. I no longer worried about this lab abnormality and that lab abnormality in his chart, and saw God's grand promise to bring him back to India. I am certain that God follows through with His promises once He makes them.

Perhaps what sets a Christian doctor apart is the ability to have faith in God to carry out His promises for patients even when the medical data point differently.

Greg did make it back to India before passing away last week.

Love and prayers to your family, Greg. Thank you for teaching me what it means to be a Christian doctor.

On Kids and Assumptions

There are so many assumptions people make about kids. Last Halloween, a Kansas City mom had to defend her son's choice to dress up as Daphne from Scooby-Doo, as people thought the kid must be gay. Her response was, "My son is gay. Or he's not. I don't care. He is still my son. And he is 5. And I am his mother. And if you have a problem with anything mentioned above, I don't want to know you...He is 5 years old. He has no conscious sexual orientation." To be honest, I do not know how I would respond if Josh wants to dress up as Daphne, but I would still love him as my son.

This week, Josh had an awful eczema flare where he scratched his face so much during sleep that he woke up with blood streaks on his face. It completely broke my heart when I found him in his crib covered in blood stains. (He actually didn't think too much of it, as he was still his happy self when he saw that I came in to get him.) I cleaned him up as much as I could, but did not want to scrub hard to remove everything. I put some ointment on him, and we proceed with our day. When we were out and about, a woman at the farmer's market saw Josh and remarked that he had "red food stains" all over his face that were not cleaned up. The response that I was thinking was "My son is a messy eater. Or he's not. I don't care. He is still my son. And he is 10 months old. Am I am his mother. And if you have a problem with anything mentioned above, I don't want to know you...He is 10 months old. He has no conscious eating etiquette."

Instead, my response to that woman was, "That's not food, that's blood!!!" I pushed his stroller away, leaving a dropped jaw from her face.

On the Check-In Feature

The "Check-In" feature is pretty neat, huh? Apparently, everyone can now know where someone is just with the Check-In feature. Facebook now also has the ability to combine all the check-in's from different websites or apps and dump them all in your News Feed. Someone checks into a cool nightclub in the Mission, let's say, and everyone thinks oh-oh-oh-she's-so-cool. Someone checks into a gym, everyone thinks ah-ah-ah-he's-so-fit. Or someone checks into Fu King Chinese Restaurant, everyone goes ha-ha-ha-that's-so-funny. That last one is a real restaurant, by the way. I am not joking. I heard it's a pretty good one too.

However, I am starting to think that this feature is getting abused. I still think my friend at the cool nightclub is cool, the one at the gym is fit, and the one at Fu King is, well, a fob, but people are starting to check into anything. And I mean anything! From embarrassing locations like S.T.D. clinics, or just plain who-cares locations like a nose-trimmer salon...there are certain locations you just should not check into online and announce to the entire internet community. Just sayin'.

Okay, I am exaggerating a little in my examples, but you know what I mean.

If I were a stalker, this Check-In feature would be my favorite. Too bad I am not though. Unfortunately, I lead a pretty boring life to justify using the Check-In feature: wake up --> change baby's diaper --> baby pees all over the wall while his diaper is open --> I clean up wall --> feed baby --> burp baby --> do baby's laundry --> clean up slobber that baby wiped all over the floor --> put baby to nap --> yell at baby not to put a dust bunny in his mouth --> yell at baby not to play with his genitals in public --> read to baby --> repeat five times --> put baby to bed.

They need to make a Check-In feature for babies.

On Medical Unnecessities

I have had some great doctors, and I have had some bad doctors. When I say "bad doctor," I do not mean a doctor that one hears on the news who got his fake medical degree online, prescribes narcotics to his dogs, and eats overpriced cupcakes. Those doctors are scary, yes, but to me, a "bad doctor" is also someone who practices like Pavlov's Dog, merely responding the same way to a medical situation repeatedly regardless of patient variables. Instead of using critical thinking skills, he relies on some sort of Pavlov's Medical Algorithm. Wow, imagine how dangerous it is to have Pavlov's Dog as your doctor giving you robotic diagnoses.

Oh wait, I have just been informed that is the function of WebMD.

Anyhoo, back to what I was saying.

Last week, I had some blood drawn. I spent 20 minutes driving to the hospital, 15 minutes looking for parking, 5 minutes to walk to the lab, 20 minutes waiting in line at the lab, and 5 minutes getting blood sucked out by a medical mosquito. The next day, I got a frantic call from my doctor's office stating that my glucose level came back at 23. To the non-medical folks out there, a glucose level of 23 means that you are, um, dead. More than dead actually, you have to be dead for maybe 970,341 hours to have that number. The nurse on the phone basically wanted to make sure that I was not dead. I informed her that, indeed, I am not dead and that this is most likely a lab error. (Lab errors occur quite often, as a matter of fact, so I was not alarmed.) She wanted me to get another glucose level drawn just to be sure. I was reluctant to do this, because I did not want to spent another 20 minutes driving to the hospital, 15 minutes looking for parking, 5 minutes walking to the lab, 20 minutes waiting in line at the lab, and 5 minutes getting blood sucked out by a medical mosquito just so that my doctor can have the peace of mind that I am not dead.

Dr. Pavlov's Dog's office thinks that any critical lab result should be repeated. This is mostly true; I agree that dangerous lab results should be repeated for accuracy. However, if this doctor's office took time to get to know the big picture that 1) I am a sleep-deprived new mommy who does not want to spent 20 minutes driving, 15...yada yada yada, 2) I have no history of hyperglycemia or hypoglycemia, even after eating cupcakes with lots of frosting, 3) I recently had glucose checked and it was normal, then it would make sense that I do not need to repeat this lab.

This morning, I got a call from my doctor's office again. It was to convince me that I have not seen the doctor for a year, and should schedule an annual physical. This is also mostly true; I agree that most people should see their doctor once a year. However, if this doctor's office took time to get to know the big picture that 1) I am a sleep-deprived new mommy who does not want to spent 20 minutes driving, 15...yada yada yada, 2) I have no new concerns to address, 3) I am a doctor myself, an annual physical is really not necessary for me. Apparently, Dr. Pavlov's Dog's office still wants to see me, because they do not trust that I can pronounce myself undead. Maybe I should consult WebMD then; that seems more reliable to a lot of people...

Medicine is an art. As a doctor, I always look at each patient individually, as no one is alike and no situation is alike. I strive to never become Pavlov's...well, you-know.

On Cupcakes

I recently went to Sprinkles in Palo Alto for a cupcake, because, you know, my husband likes risking his life driving in Palo Alto with Cal license plates. First of all, let me say that I like cupcakes; not love, just like. To me, it is essentially regular cake batter with frosting on top. What a concept, huh, cake with frosting. But somehow turning this cake with frosting into a smaller circular shape ends up costing the consumer three times as much. Most cupcakes are dressed up too, usually with some pastel color hat or frosting, snappy ribbons or sprinkles, and wrapped in a shiny skirt or cup. Cupcakes are treated like babies! Actually, I take that back. As a new mom, I do not treat my baby like that. A day that ends with less fecal material on his bottom than the amount he produced is considered pretty good treatment by my book.

I wanted to try Sprinkles because it has gotten a lot of raves from celebrities. I got the red velvet cupcake. I was not impressed at all. Earlier this year, my friend Julie gave me a delicious recipe for red velvet cupcakes, so I like to toot my own horn and say that my red velvet cupcakes are better than Sprinkles. Actually, it is her recipe, or whoever-she-got-the-recipe-from's recipe, so it is somebody else's horn.

Cupcakes seem to be the trendy thing for young people these days, including guys. Perhaps this is due to the fact that Sprinkles cupcakes made an appearance on the show The Girls Next Door. I can imagine a typical conversation between two guys on a Friday night as follows:

Person A: Hey man, what are you doing tonight?
Man: I am getting a cupcake.
Person A: Wow, you are so cool, not sissy at all.

Trendy foods used to be giant cookies, then fro-yo, and now these mini-cakes called cupcakes. As the portion size with each successive trendy food gets smaller and smaller, the average American B.M.I. gets larger and larger. This is exactly why I am cooking up a nice 50 oz. ribeye tonight and finally losing my baby weight.