When ‘Talk to Your Doctor’ Goes So, So Wrong

Posted by on September 10, 2021 7:00 am
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In the battle against vaccine hesitancy, many officials have suggested that people talk with their doctor if they have concerns about getting vaccinated. This advice makes a certain amount of sense. Primary-care physicians are typically the doctors patients trust most, and doctors deeply understand the benefits of vaccines. The American Medical Association has claimed, based on a survey it conducted, that 96 percent of doctors are fully vaccinated.

In recent weeks, though, I’ve heard from several people with an interesting excuse for waiting to get vaccinated: They say their doctors told them not to. Most of the people I spoke with requested anonymity so they could share sensitive health information. Most would also not give me their doctors’ names in order to shield the providers from negative consequences. The doctors whose names I did get did not return my calls or declined to comment for this story, leaving it unclear what they really think about vaccine exemptions. Some of the people I spoke with may simply be vaccine-hesitant and trying to blame a doctor for their own choice to delay or forgo getting a vaccine. But because doctors are a large and relatively diverse group of people, with varied training, credentials, and personal politics, it makes sense that some doctors would have incorrect views about vaccination.

“I do get a sense that some doctors may either recommend against vaccination or support a patient’s view of not being vaccinated,” Kimberly Blumenthal, an immunologist and drug-allergy researcher at Massachusetts General Hospital, told me. Many people have come to Blumenthal for a second opinion after their primary-care doctors told them not to get the jab.

She tells them that vanishingly few people can’t get either an mRNA or the Johnson & Johnson vaccine. Several medical practices told me they have zero patients who meet the criteria for a medical exemption. People who are allergic to an ingredient in one of the vaccines should simply get a different kind. Pregnant? Immunocompromised? Already had COVID-19? You should still get the jab, experts say. In rare cases, people might need to wait a few days or months before being vaccinated, and people who had an allergic reaction to the first dose of a Pfizer or Moderna vaccine might not be able to tolerate the second shot. But “really the only reason not to get vaccinated is you’re under 12,” Céline Gounder, an infectious-disease expert at New York University, told me.

Some doctors might be overestimating the side effects of the vaccines, especially with patients who have complicated medical histories. Primary-care doctors, for example, are often stretched thin and may lack the training to address hyper-specific questions about a new vaccine. “People are often using chronic medical conditions as a reason not to be vaccinated,” Gounder said. But those are usually the people who should immediately get vaccinated. “Those people are at higher risk for severe COVID.”

Plus, some doctors don’t like recommending new things or pushing people beyond their comfort level. Patients get angrier and more litigious when they suffer side effects than when they skip vaccination. “You’re not going to get sued for not vaccinating somebody; you’re going to get sued for a complication,” Gounder says.

One woman I spoke with said her doctor implied that there was no need for a COVID-19 vaccine because the virus is “easily treated.” Another woman, who has a history of severe allergies (but not to the ingredients in the COVID-19 vaccines), said she was told, “I understand why you wouldn’t want to get it. I wouldn’t get it either. You don’t need to get it.” Paul Malarik, a doctor who helps run mobile vaccine clinics in California, told me he encountered a woman whose personal doctor suggested that the vaccine causes infertility. All three of those individuals eventually got vaccinated, but not everyone does.

Brianna Baker, a 22-year-old law student, told me that a childhood illness left her with shrunken arteries, which put her at risk of myocarditis, or inflammation of the heart. Though she would otherwise want to be vaccinated against COVID-19, she said her doctor recommended she skip the shots, because myocarditis is an extremely rare side effect of the Moderna and Pfizer vaccines. Besides, she had COVID-19 a month ago. It was a mild case, she recovered quickly, and now she has COVID-19 antibodies. “You don’t choose to be sick, but you do choose to get a vaccine, and that’s kind of what is a little bit daunting,” she told me. (Baker’s doctor did not return several calls and messages.)

I asked Baker why she wouldn’t instead get the Johnson & Johnson vaccine, which has no association with myocarditis. Baker said she has a family history of blood clots, which have—also very infrequently—been associated with the J&J shot. Blumenthal, though, told me that neither of Baker’s reasons for not getting vaccinated is valid. “I can’t think of one absolute contraindication to all the vaccines,” she said.

In other cases, doctors’ personal vaccine hesitancy may seep into their practice. Malarik read me several vaccine-skeptical messages from Doximity, a social network for doctors that has a history of hosting misinformation. “FDA-approved drugs did kill thousands of people in the past,” Malarik said one rheumatologist posted to the site recently. Another, he said, suggested that vaccinated people spread COVID-19 better than naturally immune people. In June, the Association of American Physicians and Surgeons, a group of right-wing doctors, eagerly publicized the results of a nonrandom online survey it conducted in which hundreds of respondents claimed to be doctors who hadn’t been fully vaccinated. Last week, hundreds of people lined up outside a Florida chiropractor’s office when they heard he would sign school-masking exemptions. (The district then updated the form to clarify that chiropractors did not qualify.)

Doctors who wrongly tell patients not to vaccinate may not face punishment. Physicians are governed by state medical boards, which vary widely in the sanctions they impose on misguided medical providers. They tend to go easy on doctors, whom they see as their well-intentioned peers. These boards are complaint-driven, which means that if, say, a vaccine-hesitant patient never complains about her vaccine-hesitant doctor, the board may never hear about it.

People who were told not to get vaccinated by a doctor face a difficult bind when it comes to vaccine mandates. Many university and workplace vaccine-mandate forms have a “medical exemption,” but what qualifies as an exemption is not clear. Baker, the woman with the fears of myocarditis and blood clots, said her law school would not accept her reasoning for remaining unvaccinated, and she transferred to a different university to finish her degree. (Her former law school declined to comment on her case, citing privacy reasons.)

Other students might face more flexible vaccine exemptions. Portland State University, for example, has a vaccine form that accepts as an exemption “an underlying medical condition that would put you at risk if you were to receive the COVID-19 vaccine.” When pressed, the university’s health-services director, Mark Bajorek, told me that acceptable exemptions would be an allergic reaction to the first shot, but also if the person “can’t tolerate lipid nanoparticles.” (“This is not something I have heard of, and I’m not sure how they would know this and what this means,” Blumenthal said.) Ultimately, Bajorek said, “​if it comes across my desk, and it’s signed by a physician or a health-care practitioner, and it looks okay, then I wave it on.”

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