Building Trust in a Climate of Fear and Misinformation

A Conversation With Dr. Jan Peace and Dr. Lawrence Yang

Perhaps no public health topic has been so polarizing — and so frustrating to the medical community — as the anti-vaccination movement.

Parents, fearful of harmful chemicals, autism, “Big Pharma” and other threats that they associate with vaccinations, are opting out of having their children vaccinated in record numbers. As a result, diseases that were once believed to have been eradicated are seeing a resurgence.

Measles, one of the more common vaccine preventable diseases, has been reappearing in outbreaks across Canada and the United States, with vaccine refusal believed to be the primary driver.

In BC, there were 22 confirmed measles cases between January and April of this year.

As with with so many public health issues, family physicians are on the front lines of the vaccination challenge, having difficult conversations with patients and building trust where misinformation has eroded it. 

In order to begin a dialog around the anti-vaccination movement, and how family physicians can navigate these challenging conversations in their own practice, we spoke with two Division members — Dr. Lawrence Yang and Dr. Jan Peace — to get their perspective and insight.

“They’re Afraid”: Why Patients Choose Not to Vaccinate

“I think we’re in a crisis of trust,” says Dr. Yang. “When you lose trust in politics, you lose trust in the associated institutions, including health care.”

Among Dr. Yang’s and Dr. Peace’s patients who are fearful of vaccinations, some ascribe to conspiracy theories (for example, that vaccines contain unsafe levels of mercury, or were made from dead fetuses); some have suffered trauma or abuse at the hands of government systems or institutions (residential school survivors and their descendants are one example); some have friends whose children have autism, and are fearful for their own children; others doubt that the benefits of vaccinating outweigh the perceived costs, and view vaccinations as “unnatural” or “full of chemicals”.

The common thread for all of these patients is fear.

Dr. Peace also believes that a lack of understanding about herd immunity, and the fact that many vaccine-preventable diseases haven’t been seen on a large scale in a very long time has led some people to become complacent - either unaware of how bad a disease can be, or not realizing that vaccine-preventable diseases can come back if enough individuals refuse vaccination.

How can a family physician break through a patient’s fear and help them make the best decision for their child, themselves and their community? It might be useful to start with what won’t work.

What Hasn’t Worked: Blame and Fact-Checking Will Not Change Minds

When faced with an individual who is refusing to listen to reason, and making a choice that could lead to harm either to their own children, or to other vulnerable members of the population, it can be tempting to react with frustration.

“It can be so frustrating, the belief system these patients have,” Dr. Peace empathizes. “They can’t seem to hear the facts.”

From scathing social media posts to doctors who refuse to treat unvaccinated patients, the public backlash against anti-vaxxers, both online and in person, has been heated, to say the least.

But these responses haven’t done anything to improve the situation, as the anti-vax movement has continued to grow.

“We cannot come at the problem with an attack,” says Dr. Yang. “You can’t jump to blaming, because you’re destroying trust, and the likelihood of converting that patient decreases significantly.”

Nor can physicians simply provide facts and expect patients to see reason.

In fact, a study published in 2015 found that when people’s false beliefs about the flu vaccine were successfully corrected (that is, even when people accepted that they had been mistaken), they became paradoxically less likely to get vaccinated.

All of this suggests that a vastly different approach is necessary in order to truly change minds about vaccinations.

“The Number One Approach is Listening”: Building a Foundation of Trust

According to Dr. Yang and Dr. Peace, having conversations with patients who are resistant to vaccination is the only avenue a family physician has for changing their minds.

And the most important part of those conversations are the listening. “It’s all about asking questions, not telling them what to do,” says Dr. Yang, who promotes an approach termed “humble inquiry” by Edgar Schein, author of “Helping” and “Humble Inquiry”. This approach involves seeking to understand a patient’s concerns and fears - the “why” of their refusal to vaccinate — first and foremost, while reassuring the patient that it is ultimately their choice.

Listening to the patient, empathizing with them, and emphasizing their agency all contribute to building a foundation of trust.

It is only once this foundation has been established that a physician can begin to address a patient’s concerns.

Dr. Yang does this by walking the patient through the stringent procedure doctors and manufacturers must follow when creating, delivering and administering vaccines. He reassures patients that of the thousands of vaccines he’s administered, none have produced bad reactions.

Finally, Dr. Yang seeks to help the patient understand that vaccinating is something they can do to protect vulnerable people - children with weak immune systems, infants, the elderly. In so doing, he leverages the patient’s concern for their community. “This can be hard for an individual to grasp,”says Dr. Yang, “so it becomes the job of family physicians to help people see their life as part of a bigger community - to make those connections. What we do with our immune systems have an impact on others.”

While Dr. Yang often has the opportunity in his practice to meet with patients on a recurring basis, he emphasizes that it can take as little as 5 minutes to have a good one-on-one conversation with a patient about vaccinations.

“As family doctors, our calling is to build a relationship of trust with our patients,” Dr. Yang emphasizes. “The only way is with kindness.”