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A Matter of Perspective

I had the privilege of working as a scribe in oncology last year. For several months, we had to severely cut back who was able to come into our clinic. Our patients receiving chemotherapy still came in person, but family members were no longer able to accompany them, robbing them of that crucial emotional support. Many of our other follow-up visits were switched to telehealth: a safer, but not ideal alternative.

Then, we began to have hope again. The vaccines received FDA Emergency Use Authorization.

It was exhilarating to document, finally, phrases like, “They report getting their first COVID vaccine dose.” And, “Their family is fully vaccinated against COVID.” And, “They were able to hug their (vaccinated) grandchildren for the first time in over a year.” It did not bring back full normalcy, but it brought back some patients in-person to our clinic, which felt like a powerful  first step.

Many of our patients were excited to let us know they had gotten the vaccine, offering that information up before the doctor had even asked.

But some patients did not get vaccinated. They cited uncertainty about long-term effects. Others were afraid of side effects or felt they could not take time off work. Some declined to share their reasons.

The doctor was respectful and thoughtful. I could tell she made the patients feel listened-to, their concerns heard. She offered polite counterarguments. She wrote work excuse letters for patients who needed them.

Some patients were convinced by the science. Some were not. There was one phrase she would use, though, that kept coming back. Of all the approaches she used, this was the most successful. It varied based on the patient, but it generally went something like this:

“Think about all you have been through. You have been so resilient. You endured chemotherapy. Compared to that, getting the vaccine is so much easier than risking COVID. You trusted me to treat your cancer, so please trust me on this. Please get it, for me.”

The success of this approach was not universal, but it far outstripped all other approaches she tried. Perhaps it is because it does not invalidate people’s fears but instead appeals for two shifts in perspective: (1) it contextualizes the magnitude of “risk” against something much more difficult that they have already experienced, and (2) instead of a negative message, it appeals for trust to triumph over fear.

Brian R. Smith
Stanford, California

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2 thoughts on “A Matter of Perspective”

  1. As a survivor of cancer and chemo myself, I applaud the doctor’s self-restraint and success, however meager. I wouldn’t have been able to maintain the tact. My version of the same thing would be more like, “You underwent chemo in the hope of saving your life, and now you’re willing to risk losing it over a bunch of misguided fears not shared by the entire medical & research community? Why did you trust them/us with the chemo? Chemo’s success rate is far lower than the vaccine, and some of its many side effects can last a lifetime. Do you care less about saving your life than you used to? Do you care as little about saving the lives of others as you do about saving your own?

    Do you think that the statistics about cancer deaths are real but the ones about all the COVID deaths are not? Did you also used to think you were immune from getting cancer before you were diagnosed? If getting vaccinated will make you embarrassed in front of your friends, we can make it our our little secret, and you can continue to pretend that you proudly don’t care about your health or that of those around you. If you would consider getting vaccinated because of me or what I might think of you, I assure you that I will either: 1) be glad that you’ve come to your senses or 2) conclude that you are a complete moron. Your choice.“

    1. Hi Kathleen, thank you for your reply and your candor. I deeply empathize with the frustration and bewilderment behind your version. Some of these misconceptions feel like “doublethink” from Orwell’s 1984 – simultaneously holding two diametrically opposed beliefs, which just leave us confused at how we got here.

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