P4P Talking to Vaccine Hesitant Parents
[00:00:50] Dr. Alicia: All right, everybody. Today, we have Dr. Rebekah Diamond, who is a board certified pediatrician who works in as a pediatric hospitalist in New York with us. [00:01:00] And she is going to talk with us a little bit about how to have conversations with vaccine hesitant parents. Rebekah, why don't you start off by telling us a little bit about yourself? Okay, I gave away a few of the details, but.
[00:01:14] Dr. Rebekah Diamond: Thank you so much. Thanks for having me. So I am a pediatric hospitalist in New York city. I work in the city and I'm a assistant professor of pediatrics at Columbia university. I deal with a lot of vaccine hesitant parents in the real world. I deal mostly with them online. I do a lot of social media outreach, and that's actually how I was able to connect with this amazing podcast. So I'm just very excited to be here and talk about, how to get people to fall in love with vaccines. Yeah.
[00:01:42] Dr. Alicia: So how we first met was we have a a patient focused pregnancy and new parenthood, Instagram called She Found Motherhood. And there was a question around the COVID vaccine and breastfeeding and pregnancy and safety and discussing concerns and Rebekah actually from her Instagram, so Parent Like a Pediatrician actually [00:02:00] reached out to this person, pulled them over to her site and had a really good, curious conversation via the Instagram, how that's a conversation, but you know what I mean? And actually addressed her concerns and discussed the what's out there. And change this person's mind. And so I reached out to her because I know a lot of us are strapped for time around how to have these discussions and there's, how do we battle all of this misinformation or disinformation that's out there in such a limited amount of time. And so we thought perhaps we can do this podcast together for providers around how to have those conversations. Why don't we chat about what is your approach? Somebody, you have got a little baby who's six weeks old and uh, you discuss have they booked their vaccination appointments. That's usually how it would go for me. Oh, have you guys, talked with public health, if you've gotten your vaccination or immunization appointment booked for kind of that two month mark, and then they'll say I don't really know if I want to do that. I'm worried about X, Y and Zed. So how would you approach that conversation when that comes up?[00:03:00]
[00:03:00] Dr. Rebekah Diamond: Yeah, it's the first thing I want to acknowledge is that because I'm a hospital pediatrician, I do not have to be beholden by what I think are very similar in the United States and Canada. These really insane time restrictions with a visit. A vaccine conversation could take hours and, sh should be allowed in a perfect world to have the space to do that, and the time to do that. So I'm very fortunate in that when I encounter these conversations, it's someone who's in a hospital setting is I'm able to come in and out of it more or someone in my life for online. I haven't done well-child visits since residency and I can't imagine being tasked with, let me just tell you everything you need to know about your newborn baby, and also get you onboard with vaccines. I don't even know. Th that's I understand how overwhelming it, that must be.
[00:03:44] Dr. Rebekah Diamond: The way I start, is the same, no matter what, and it's that kind of cliche, but just listening and almost playing dumb questioning. Oh, wow. Why is that? What have you heard? What's bothering you. It's a little bit trite and it's it's that med school [00:04:00] 1 0 1 open and open-ended questions that we of course don't have the time for. We wish we did, but again, you might be surprised. I've been surprised by what the concerns have been, and I've just assumed they were totally something different. Sometimes they've been like, oh, I'm worried about this because of this one, really easy to debunk thing. And then you do that and then you talk at the next visit and it's kind of gone. That's the really uncommon and really nice outcome. Usually it's much more of a dark rabbit hole of misinformation that you start to wade through. But I just, I always ask, oh, that, oh, why are you worried about vaccines? What's going on? What have you heard?
[00:04:38] Dr. Alicia: Yep. So compassionate curiosity. I like to say I'm learning that in my world and approach things with compassionate curiosity rather than assumptions, because you're right. We make all these assumptions and then in our brain, it's totally different than what their concerns are for whatever reason. But yeah. So first of all, opening up, asking some questions, discussing what their concerns are. And again, in our time limited situations, maybe. [00:05:00] Not an entire conversation you have in one visit, maybe you could say, okay well, I'm really interested in understanding more about this. Can we book a separate visit to actually discuss this in a bit more detail? It doesn't all have to happen in one visit and that might actually be too overwhelming for some people. Yeah,
[00:05:17] Dr. Rebekah Diamond: No, I think that's such a great scale. And of course, you know, I haven't done these visits for a long time and not at my clinical peak where I am hopefully approaching soon. But the idea of saying I'm going to put a pin in that I hear all your concerns.
[00:05:30] Why don't we schedule a telehealth visit or an in-person or why don't we dedicate some time? So this does not have to come at the expense of other things or bleed into other things. I think that's really smart. Yep.
[00:05:42] Dr. Alicia: So the next step you talk about is validating their concern. Yeah.
[00:05:46] Dr. Rebekah Diamond: And it can be hard, especially at the end of a long day when you've seen really sick kids or you have a lot going on at home, this is personal experience for me where I'm just like, oh my God, you really don't want the t-dap [00:06:00] vaccine, meanwhile, I have another kid with pertussis who I'm worried about sending to the ICU. I have my daughter who I would just love to get her a COVID vaccine, so we could do this. And you just, you want me to sit here and validate the fact that you just don't want this awesome thing. I, lot of countertransference in my own human emotions. I, I have that and I always sit with that and say, yeah Even if I don't think the content of what they're saying or thinking is valid, the very bottom line, visceral worry and vulnerability to being preyed on that something bad could happen to your kid or that there's something to be distressful or worried about, that I always can relate to. Maybe not this exact situation or something, even that close to it, but I've had plenty of even irrational by my own standards, thoughts about my daughter of, related to, pediatric practices or non pediatric practices, just parenting decisions every day. And so I do my best to say, this is just them doing that with something [00:07:00] else. They don't have the luxury of the perspective that I've been able to have. They've been inundated with information in a way I have not, and they don't have the knowledge basis to push back or the support system to push back. And that helps a bit too. And then just give it as much genuine validation and empathy as you can. You can just make sure you're saying real statements, which is I'm so sorry that you have to sort through all of this information. It sounds really overwhelming or, yeah, that is a lot of confusing stuff out there, or yes, there are a lot of concerns that are being pushed out there. You don't have to say they're true. You don't have to say that you would necessarily sit there and ruminate over them, but it's just a fact, think about what parents are up against. If you're a parent, it's just, there's a lot out there to sort through, right?
[00:07:44] Dr. Alicia: I think we can put that in perspective that many of us providers I know with my son, do I do baby led weaning or do I give him purees? Right? I researched that for like weeks.
[00:07:56] Dr. Rebekah Diamond: Yeah. And there might be. Yeah, it doesn't. And there might be someone who's oh my [00:08:00] God, you dummy. That doesn't matter. Yeah.
[00:08:02] Dr. Alicia: I say that to my colleagues now but again, that was a valid concern for me. And that was like a very minor part of health. We're talking about like vaccination here. This is big stuff. And I think one thing that you broached upon, I'm going to, I'm going to delve on into that, cause we actually did a podcast together about, which is for patients around the top five questions that parents have around vaccinating their kids and going through those questions. So if you're interested in kind of some of those answers, check that one out it's on the She Found Motherhood Podcast, but one of the things we talked about at the end is, and you mentioned it is they're being preyed upon. These poor parents who are just trying to do their very best for their newborn babies. These kids are like two months old, right? When they're having to make these decisions, they are being preyed upon by multimillion dollar industries who are out for their own good and don't care about these children to stop them from getting vaccinated. So they buy their products like it's, so if we can [00:09:00] think about it in that perspective, like that's a really, crappy things that these new parents are having to go through. And so maybe that gives us a little bit more empathy or compassion that we can stand by these parents and understand a little bit more where they're coming from so we can move forward in discussions with them rather than getting, I know I often get my backs up. I'm like, what is you? Vaccine. There's so much evidence around this. You can't, you're crazy to think that this isn't, but they're being preyed upon by someone who is taking advantage of their vulnerability and their love for their child. And so I think we all need to keep that in the back of the mind, which is really hard when you're at the end of the day and you're exhausted and all those things.
[00:09:39] Dr. Rebekah Diamond: Yeah. And that actually brings up a good point that I just want to explicitly make, which is one of the ways actually, the main way that these anti-vaccine propaganda can prey on parents is they are aggressively empathetic. Like they come at this, they use a lot of different strategies. I've spent, somewhat of an informal career on social media, trying to [00:10:00] understand them, because I think it's important to know what we're up against. They are constantly telling parents that they know what's best for their kids, which is true, that they hear them, that medicine doesn't hear them, that their doctors don't listen to them that they're, that their government, their health agencies, that everyone is out to dismiss them, disrespect their unique bond with their child and that they alone, through the some logical loops that I, hoops that I don't really know how they get there, but that they alone are able to see this beautiful bond between parent and child and nurture it and nourish it and that they only want what's best for them. So I think they have already pit us in the defensive position, in a variety of techniques. And a lot of them are cognitive biases and logical fallacies, but a lot of them are just emotional manipulation. So they're entering these conversations. Being told that we don't care about them as doctor. That we're not going to listen to them, that we don't [00:11:00] have the time, which is true. And it's it's kind of mean that they are taking advantage of our under-resourced system, but that is what parents have heard by the time they're coming in hesitant or even anti-vaccine. And so thinking about empathy, is almost like our own tool and weapon and not saying, okay, we're just going to be dismissive and exhausted, even though sometimes that's just all you want to do or all you can do. If you feel like that's where you are, maybe it just ends for the day with the curiosity and you regroup and do it later, because I think it's better to maintain understanding and kindness than to go down a path of defensiveness, it's not necessarily going to leave where you think it's going to lead.
[00:11:40] Dr. Alicia: Yeah. And I think this comes to your third year, third tip or point is making sure that any dismissal of misinformation is actually targeted at the people who spread the misinformation, as opposed to the parent. Don't attack them for being concerned or for having those kind of. Do the same thing that those big companies are doing, right? They're [00:12:00] attacking them, provocateurs for not having the time or not taking the people's best interests into heart. So the same thing. So don't attack the parent for having misinformation attack the source of that misinformation.
[00:12:10] Dr. Rebekah Diamond: Put the blame or the onus or the wrong on them. This is something I did not do until I became a parent, and just had a lot more experience in this world. I used to absolutely be like, oh my God, it's another anti-vax parent on my schedule. I can't deal with these people. I can't deal with them. And there's a lot of frustrating things about these interactions and the parents. And, every family has its own frustrating challenges when you have these conversations, but really it was so helpful for me to say I'm really angry, mad, enraged, livid, ready to burden down something. And that's something is the people who are promoting this. It's not the parent who, sure is being stubborn, or sure is showing these logical fallacies, or yes is not necessarily listening to me in a way that I would anticipate or hope for. I can be [00:13:00] frustrated with them, but I'm not angry at them. And I think that really has been emotionally protective for me. And also it's just more productive in the end.
[00:13:09] Dr. Alicia: Yup. So let's review this kind of quick visit. So first of all, you're going to, you're going to be compassionately curious or ask lots of open-ended questions, try to understand what are the actual concerns, where are there, where are their concerns coming from then you're going to validate their fears and their worries and show them some empathy and separating them as parents from this anti-vax piece. So don't dismiss their concerns, dismiss the misinformation. So we've gotten that a piece of the puzzle. So how do you present to them the info, the scientific info, all of the data, the years and years of research, that decades of research showing that vaccines are safe, do you have do you discuss that in person and you might have more time to do that, or do you have some great resources that you would send them to and then bring them back to discuss it later?
[00:13:56] Dr. Rebekah Diamond: Yeah, I definitely do have more time, but even if I have a lot of [00:14:00] time, then I do my best to stop myself from actually just out the gates, sitting there and going through it point by point. I think people really need time to sit with good resources first. A lot of the, you'll find one of it is just being smart with time. You can sit and review every single vaccine ingredient one by one with a parent, but some parents just need to see it on the chop vaccine information website. The children's hospital Philadelphia is my absolute favorite. And we can you just Google chop vaccine education center. It's truly fantastic. Or, and, or they can have an app. I think parents can scroll through on their phone. It's so good. I will also, I have my own handouts, so I will give it to them and it goes through, very much like we did in our other podcast episode the top questions I get and how I answer them. And it gives more of the nitty gritty. I find that both having parents use kind of their own time to do that and think through that rather than it being sort of. I've been using a lot of like [00:15:00] legal analogies, but this kind of cross examination of me, them asking a question and me continuing to answer and this back and forth. It's not that it's necessarily an antagonistic thing, but it becomes very hard to not make it look like I'm just trying to prove my point. If I haven't a rebuttal or answer for everything, where if I have a resource for them to sort of, more freely wander through and look at their own specific concerns and spend more time on that. Then the next time I see them, if we can sit down and talk about it, we can usually hone in on a few different things. But maybe not the whole big picture. Maybe we just sit there and we talk about preservatives. Or that, some sort of vaccine ingredients that really they don't feel good about. Or we sit there and we talk about Andrew Wakefield because they still feel like something is missing there. I think there's nothing, he's the worst. He's a fraud. We all know that, but the true worst. But regardless if I can give someone time and space and reputable resources to, it, I think it stacks [00:16:00] the combo in my favor, the deck in my favor, they've been keeping in mind, I'm one person and they've just seen from the anti-vax side, hundreds of people and testimonials and all sorts of really effective campaigning.
[00:16:15] I think psychologically, it's just an important for them to see that there is as much on the vaccine side, it's a lot more compelling. There's as much, if not more information. On stories from people and stories from parents and the science behind it. And the. Influencers behind it. I think they need time to really see all that themselves before we can get into a while.
[00:16:38] Dr. Alicia: Awesome. So you send them always with some great resources that they can peruse and then set up another meeting with them, set up another time to come back together and answer any kind of specific questions that they might have that they couldn't quite figure out with that information or they still have long lasting questions around that. Now you kind of talk about in your, you gave me [00:17:00] some points that you'd like to go through. Now, at this point, you're going to change the shift, right? You're going to change the shift to focus on the positive aspects of vaccines. So you're going to get out of using your lawyer analogy out of that kind of defendant or defensive seat and move, shift the conversation into a more positive forward moving discussion. Tell me a little bit more on that.
Turning Hesitancy Into Excitement
[00:17:18] Dr. Rebekah Diamond: Yeah I try to do that from the get-go a little bit too. It's you know, it's a little bit of an art. And, there's been a lot of time and experience for me to hone this. But I, from the beginning, try to always put into the conversation. You know, I'm interested in this, or I want to help you with this because I am so excited about vaccines. I think they're so important. They're so safe. I was so excited to vaccinate my own daughter. Keeping it very human and personal and positive. I like to sprinkle that in pretty heavily throughout. And then when it's time for us to sit down and talk about it, always like to end the conversation after all the questions and concerns with the truth, which is, listen, this is your decision. You're a parent either, you're a new parent, or this is your 10th [00:18:00] kid, or what have you, your life is going to be filled with really hard risk benefit decisions for your child, but you're more than capable of doing it, right? You're a great parent. You care, obviously you care. If you're spending so much time and energy looking at this, you're coming back for maybe a second visit with me just to talk about it. Taking time out of your day. You're totally capable of this. I am here to tell you not to, like you said, not to defend vaccines, not to say that there's some sort of scary thing I need you to be on board with. I'm here to let you know that if you choose to get these vaccines, that is awesome because they are awesome. Here's what they do. Here's all the amazing benefits. Here's why they are lower risk than 99.9, 9% of all the other decisions you're going to have to make in the next year. Sleep and TV and trampolines and the, everything, anything that you have to make a medicine amoxicillin for ear infections, like those are the gray areas. Those are the things that are just like [00:19:00] really stressful and annoying. This has been made to feel really stressful for you, but it's really just awesome. Vaccines are awesome. And so I love to talk about parental empowerment. I don't want to make this decision for you. I want you to know that I just recommend it support it a hundred million percent. I want you to feel confident that it's a choice you can make kind of thing.
[00:19:22] Dr. Alicia: Yeah, that's awesome. So good. Yeah, what a great way to approach it and have a conversation, because I think it is so hard in our, when we have all of this information, but I like to equate things to computers because I'm, I'm not that bad, but I don't know anything about the inner workings of computers. So if I go to talk to somebody about what's the best computer to get, they could tell me anything. And I don't know who to believe because I don't have a good background in it. And so I think we forget that because we've been inundated in this stuff since undergrad, most of us were interested in science in high school. And so we've had all of these years and all of these experiences and just slowly building our knowledge about how [00:20:00] to analyze data and how to look at studies. I'm still horrible at that, by the way. But at least I have a good basis in it to make decisions, but in the computer world, I don't have any basis. So I'll just go with whatever sounds the best, and that I'm really easily manipulatible. Don't anybody hold that against me but that's, I think we have to recognize that in our families that we're helping to support, they don't have our backgrounds, you don't have that information at the tip of their fingers or where the good resources is. So I think that's a really good way of approaching that conversation with people. So like we said, okay, so I will post that chop vaccine education center in our podcast. I will also, people can find you or direct patients, I think is a really good way of doing it to your Instagram, and that's @ Parent Like a Pediatrician.
[00:20:42] Dr. Rebekah Diamond: Yes. Please send people. I will answer. I answered DMs as the kids call them all day. And I make a lot of content about vaccines. Especially related to vaccine hesitancy like this. So please send patients to me for better or worse, probably for worse people tend to really trust social media even more than these [00:21:00] in-person conversations. There's research behind it. It's really crazy, but it's true. I'm so grateful for this podcast and for all the other social media slash doctor hybrids out there, we're just trying to get the info proactively out there. So definitely send patients our way. Yeah.
[00:21:16] Dr. Alicia: And we'll also post the I'll link, the podcast that we did on the, She Found Motherhood Podcast for also people to listen. Cause we actually go through some of the questions and the answers, so around preservatives and all those types of things. And also if you want a resource to point your patients to where your parents too, that's another good way of pointing them towards that research as well. So we'll make sure we link that, but thank you Rebekah so much for doing this with me. I think this is such a wonderful topic to talk about. And I know one that anybody who deals with parents and children, it comes up in our practices quite often.
[00:21:47] Dr. Rebekah Diamond: Thank you so much for having me.