Susan and went to iHop for a late lunch yesterday. There were very few cars in the parking lot, and the seating in the restaurant was respectful of social distancing. We sat in our booth reading emails and FB as two more groups entered the restaurant. The first, a Hispanic couple, were seated close to the entryway. A second, a group of middle-aged Anglos, was seated just behind us in a large corner booth with circular seating.
The thing about these smallish restaurants, especially when they are sparsely attended, is that the patrons’ conversations carry well throughout the place. In other words, you can’t help but overhear the convos. The Hispanic couple was quiet enough in their repartee that it did not carry to our booth. The middle-aged group immediately behind us seem to make no effort to keep their voices down.
It quickly became apparent that they were anti-vaxxers and COVID deniers. One allowed as how a niece who had been an LVN at a local hospital was sponsored by her employer to complete an RN program. Later, when she refused to get vaccinated, they fired her. Everyone at the table expressed their dismay at what they perceived as a gross injustice. The newly minted RN had apparently “done her own research” and uncovered the fact that vaccine studies, as she saw it, concealed vaccine adverse effects. It didn’t matter that physicians and scientists supported the safety and efficacy of vaccines based on clinical trial results – that is, adverse outcomes in the vaccinated group were no more common than among the unvaccinated control group. Not everyone is versed in statistical analysis.
Austin is a hotbed of anti-vax sentiment since the discredited gastroenterologist who published conterfeit research linking vaccines to autism settled here in my town. He has a faithful following here. Sigh.
As their conversation continued, it became clear that it was the medical and pharma research cabal that was trying to get everyone vaccinated. It was all a big conspiracy. Conspiracy thinking has become such a deep part of modern conservatism (especially Evangelical conservatism) that there is no reasoning with such ideas. Their ideas are not about facts or science or logic; they are about beliefs and group membership.
Later in the afternoon, we had a long-time friend over for what he describes as a bullshit session. Before the COVID apocalypse, we would meet almost weekly at a local bistro for a libation and a chat. The last couple of years, we’ve met here for a home meal or maybe somewhere else for an open-air meal. We always talk about our kids, grandkids, news regarding our mutual friends, our work and retirement activities, and so forth. It’s all quite prosaic.
At one point my friend started to tell me of a recent patient visit (he’s a physician). It was like reading or listening to a Medscape Diagnostic Challenge. “A 19yo African-American female accompanied by an older relative comes in for evaluation. The young lady has had abdominal pain with bloody bowel movements for several months. She is losing weight and is now down to 90lbs.”
At this point, I jump in. “It sounds like inflammatory bowel disease,” I interject.
“Right,” he answers. “I try to get prior medical history from them, but they are evasive. When I ask the young lady a question, she looks at her elder as if asking how she should answer my questions. Later, I look on our computerized medical record system and see that several years earlier, a younger child of the same name has been evaluated by a pediatric gastroenterologist. Her evaluation resulted in a diagnosis of Chron’s Disease (one of two inflammatory bowel diseases). She was treated appropriately – at least until she was sent off to adult medicine.”
As it turns out, she was controlled on immunotherapy until she stopped taking her injections. That’s when the symptoms returned. The older relative said that they had decided to stop therapy because of “religious reasons.” They never saw the adult medicine clinic. Madre!
My comment was that this was never about my friend or his interview/bedside manner. This was probably not about religion, per se. It was likely a matter of mistrust of a medical system that had a less than a sterling record as regards the care of people of color. “They didn’t want to give you the past medical history because they wanted you to do the entire evaluation from scratch and maybe give them a diagnosis more to their liking.” He nodded yes, but admitted to being frustrated, nonetheless. Believe me, I practiced patient-care medicine in this city for 14 years, and I get it.
All I can say is that mistrust of our healthcare system, writ large, is the problem of the healthcare system (professional organizations, hospitals, emergency services, nursing homes, government agencies like the CDC, FDA and NIH, etc.) Mistrust of individual practitioners is the problem of the individuals who harbor that mistrust. In other words, the relationships of people seeking care and those of us who are committed to providing it must be one based in mutual respect and trust. Without those things, the entire therapeutic project is doomed at least to disappointment if not abject failure. Alas.