Remembering our obligation in turbulent times

Editor’s note: This column originally appeared in APPChat, a newsletter for APP providers and staff. It is reprinted here and updated to reflect current COVID numbers.

Do I have to accept unvaccinated patients in my practice? Do I have to see unvaccinated patients face to face, or can I insist they be seen via telemedicine?

These are the questions I hear my colleagues asking.

I understand the underlying frustration that leads to these questions. We have lost one in 500 Americans to this pandemic. We see the local costs mounting inside our own hospitals, the grim totals in the Asante infographic published daily. We see the beds occupied, the ICU admissions, the days on ventilators, and the delayed surgeries and treatments. Asante has seen 169 COVID deaths in the past three months.

Outside our hospitals we see other costs rising: prolonged isolation and foregone shared celebrations; the political rifts dividing families and friends; economic costs to local businesses; the loss of day care; the loss of labor force … and on and on.

Provider angst builds knowing that the latest wave of hospitalizations and deaths was largely preventable. Places in this state (and in the country as a whole) with higher vaccination rates have had fewer hospitalizations and deaths. Regions with lower rates vaccination rates, such as Jackson and Josephine counties, have suffered more. Like most of my colleagues, I have had many patients hospitalized with COVID. None of them, nor any of the patients of the colleagues with whom I share a practice, has been hospitalized or died because of the vaccine.

As we try to convince our reluctant patients and our family members and neighbors to recognize the overwhelming evidence in favor of vaccination, it is disheartening as a primary care provider to hear: “I am going to do my own research,” or “I just don’t trust (“doctors,” “the government,” “the FDA/CDC/WHO” or “big pharma”).” The tides of misinformation rise higher every day, eroding the trust that is the basis of the provider-patient relationship. Rejection of vaccination becomes a potential signifier of further battles to come — battles over sham treatments, testing, medical literature, civic responsibility and sources of information.

Despite the exhaustion we experience trying to keep our heads above these tides, we have an obligation to see all our patients. We have an obligation not to exclude the unvaccinated from our practice or our face-to-face clinic. It bears remembering some of them are co-workers or the family of co-workers. We are a small community.

The first principle underpinning this obligation is that we — as medical professionals and as representatives of Asante — do not discriminate.

We can take steps to protect ourselves. We can be vaccinated, wear protective gear, limit time in exam rooms by gathering history through tablets or phones, and insist our patients wear masks. But we should not and cannot withhold medical care. With the precautions we have in place now, we are probably safer in clinic than we have been for most of our careers. Some medical care, for a variety of reasons, needs to be conducted face to face, whether or not a patient is vaccinated.

As a profession we have long treated those patients who are unable or unwilling to follow our advice. Nobody who goes into primary care expects that patients will do as we tell them all the time, or even most of the time. We have an obligation to recognize that an imperfect translation of knowledge into behavior is one of the defining attributes of our patients’ — and our own — humanity. By building relationships and keeping discussion alive, we hope to share knowledge and change behavior over time.

Will we win all the hearts and arms? No. But we will win far more of them by having relationships with patients than by not having them.