Jay W. Lee, MD 00:00:00 You know what I'm going to ask you next, right? And invariably that ends up bringing up vaccines.

Keith Reynolds 00:00:17 Welcome to Off the Chart with Medical Economics, a podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Keith Reynolds, and on behalf of the whole team, I hope you had a lovely turkey day. This episode, we're featuring a conversation between medical economics assistant editor Austin Luttrell and Doctor Jay Lee. He's on the board of directors of the RFP, and he's also the medical director at Integrated Health Partners of Southern California. They'll be discussing how to overcome vaccine hesitancy in patients.

Austin Litrell 00:01:03 So I guess could you just start off by just providing just a general overview of the CDC's latest recommendations on Covid 19 and pneumococcal vaccines, and what that means for physicians?

Jay W. Lee, MD 00:01:14 Yeah, absolutely. So happy to speak to that. So a couple of things. One is, around, Covid vaccines. the prevailing recommendations coming out of the public health emergency were to have a once a year booster, after every fall, similar to what we might get for the flu vaccine.

Jay W. Lee, MD 00:01:38 however, the more recent, recommendations that for certain groups that may be at higher risk for severe Covid, that there be, actually a second shot, six months after that first booster shot, in the fall. and I think the science is evolving on this, but I think it's become pretty clear that we're starting to get in a bit of a seasonal pattern. And so the fall recommendation made sense right out of the gate. from, the moment that we left the public health emergency. And I think the data is continuing to show that those who are getting hospitalized and having severe cases of Covid tend to be those who have, chronic illnesses, and typically those over the age of 50 who have, one or multiple chronic conditions. as far as, pneumococcal vaccine goes, you know, we've that's also evolved, thanks to science and data and, a lot of the, the biggest change that we're seeing in the current recommendation is a reduction in the age at which, patients might receive, that pneumococcal vaccine. Historically, we recommended, actually used to be one pneumococcal vaccine.

Jay W. Lee, MD 00:02:57 There's actually now two pneumococcal vaccines that could be given for people over the age of 65. The new recommendation is that that age range be brought down to the age of 50. and again, a lot of that was also data driven based on hospitalizations and people who are most likely to get a severe pneumonia that might put them in the hospital or worse, take their life.

Austin Litrell 00:03:19 I kind of touched on it a bit there, but as respiratory on the season ramps up, how important is it for physicians to encourage vaccinations against the flu, Covid 19, pneumococcal infections simultaneously? And what strategies do you know that are really effective there?

Jay W. Lee, MD 00:03:35 Yeah, I mean, I will say I think my patients are well attuned to what I maybe recommend once we get past Labor Day. and so I'll ask them very bluntly, you know what I'm going to ask you next. Right. And, and invariably that ends up bringing up vaccines, which is one of those important domains that we talk about with patients when they do come in.

Jay W. Lee, MD 00:03:59 and so, a I think it's, it's about being consistent with asking, and then I think, you know, I would say there's still a lot of patients who will say yes, and they'll roll up their sleeves and they'll get it done. there are, over the course of my 20 plus years of doing this there, there have been a growing number of people who've who have additional questions. And, one of my, ways of sort of approaching that is, taking a very careful listen as to what it is that they are concerned about, and then asking them, actually a set of questions about what's important to them. And so sometimes what I'll uncover from that is that, you know, it's really important to them that they're able to see their elderly relative or somebody who's in the hospital or someone that might be sick. And so, oftentimes what I'll do is I'll tie that desire to be connected with the people in their life and their loved ones with, hey, you know, it, you know, this is not just for you, but it's also for those folks in your life.

Jay W. Lee, MD 00:05:03 And would you be open to having that conversation? and then I think, you know, being being, sort of persistently and, and and pleasantly cajoling, it can help a lot, just, you know, it's that relationship. It's not like I'm some random doctor that's, coming up and just saying that. Hey, you need to have this done. It's based in trust and it's based in a relationship. And I think it's really important for, you know, patients to understand that there's a tremendous amount of value in having that ongoing relationship with your trusted, family physician. and they're there to help you sort through all of the, potential misinformation that's out there. because our job is to really make sure that that we are doing that risk benefit analysis for you as a patient and that we're, you know, taking into account the things that are important to you.

Austin Litrell 00:06:02 Right. how is the way that physicians should approach the vaccine conversation changed in the wake of the Covid 19 pandemic?

Jay W. Lee, MD 00:06:11 Yeah, I alluded to.

Jay W. Lee, MD 00:06:13 This a bit earlier, but, you know, back 20 years ago, I'd have a small percentage of patients who would say no. And, this was with regards to any, any vaccination, really. and then I think, because of misinformation, it's just made it harder to navigate. And I think, a lot of it is that sometimes patients will come to you with information that they've, gathered from sources. And so, I often have a conversation about what source did you get that information from? and, kind of ask a series of questions not to debunk or embarrass the patient, but really just to kind of poke holes in the argument. Right. And and then I think, you know, then it's turning that conversation into, well, you know, I've taken care of you for 15 years. you know, I really care about your health. And, you know, we've been through a lot together, and we've really I've been able to help you with your diabetes. I've been able to help you with your hypertension.

Jay W. Lee, MD 00:07:14 Remember, you got your colonoscopy and kind of building that rapport and reminding the patient that we're really there for their their health and their well-being. And, you know, even then, I may not be 100% successful, but at least we've had that conversation. And then I actually then open the door for further conversation. If they say no. So I know you didn't say, I know you didn't say yes this time, but is there an opportunity for us to revisit this the next time I see you? Or maybe I can have my nurse reach out to you, you know, in a week and we can and revisit that because, you know, right now, October and November is scientifically the best time for you to get your vaccine. you know, for these seasonal, respiratory illness vaccines.

Keith Reynolds 00:08:00 Oh, you say you're a practice leader or administrator? We've got just the thing our sister site, physicians Practice. Com your one stop shop for all the expert tips and tricks that will get your practice really humming again.

Keith Reynolds 00:08:12 That's physicians practice.com.

Austin Litrell 00:08:19 You talked about it there. I guess with that kind of building rapport and reminding them, that, you know, you're not some random doctor, you're you are their physician. But do you have any other strategies that physicians could employ to kind of address, vaccine hesitancy or misinformation?

Jay W. Lee, MD 00:08:33 Yeah. I mean, I think, the.

Jay W. Lee, MD 00:08:35 Old days of doctors kind of taking maybe a more authoritarian or authoritative approach as the holders of information, that era has gone because we've got the internet now. and I think really a big piece of that is, working with the patient to, to help them, to try to better understand how it is that they got to the conclusion that they got to. And then for us as health professionals to say, well, here's what the science actually says. again, not to debunk or to embarrass them, but really to create that dialogue. Because when you have that back and forth dialogue, that's the opportunity for us to create change and, the opportunity for patients to begin to think more critically about, you know, the, the, the actual science that's out there behind this.

Jay W. Lee, MD 00:09:28 And, yes, there are risks to anything that we do in healthcare. But ultimately, our job as, as physicians is to help patients weigh the risks and benefits. And what we know from vaccines, and the, the, you know, decades of vaccine, data is that by and by and, far and away, it's it's one of the most effective public health measures for getting patients to, to, prevent having severe illness or disease. And because we've done such a good job with vaccination over the last century, I think people often forget what it was like before we had vaccines. And I'm old enough to know that there are things that I experienced as a physician, on the trading side that, were were terrible to see, things like respiratory syncytial virus or RSV and how amazing it's been that, that we've kind of turned the corner on that and gotten so much better at, you know, preventing severe illness, for those who are vulnerable.

Austin Litrell 00:10:35 Right. so this is my last one. And then I'm just going to kind of wrap up after that.

Austin Litrell 00:10:41 But, there are a lot of different options nowadays for patients when it comes to getting their vaccines. Why do you think that it is important for family practices to continue to offer these services? I mean, kind of in terms of like a patient physician relationship.

Jay W. Lee, MD 00:10:55 Yeah.

Jay W. Lee, MD 00:10:56 I think when when at all possible, if a patient is able to get their vaccine at their family physician's office, I would highly recommend it, because, for a couple reasons. One is, they can have that conversation with you about, the risk. there may be other things, depending on your age and your gender and your family history that you're going to need to have addressed anyway. So, you know, it's kind of a one stop shop to be able to come in and to have that conversation and have a review of your record to see what things may be missing. and I also think, you know, there's a sense of, just sort of that connection to a Doctor Who and a and a team around that doctor who's there to sort of help you navigate your own health concerns and your own health issues.

Jay W. Lee, MD 00:11:47 and, you know, that's the place that I know that, I get the most joy out of, you know, you know, caring for patients and answering questions. But be it I know that my patients, often come back and view us as that sort of first touch point. when questions do arise, it gets very confusing, very fast when you're on the internet and, you know, unless you're absolutely certain that you're going to get a vaccine, you know, sometimes, going to the, going to a retail pharmacy or going to another location, is probably not going to be the best option for you, because they may not take the time to answer the questions in the way that you might have in the doctor's office.

Austin Litrell 00:12:27 Great. is there anything that we didn't talk about that I didn't ask you that you think is important for our audience of physicians to know about?

Jay W. Lee, MD 00:12:35 Yeah. I.

Jay W. Lee, MD 00:12:36 Think, the most important thing is, you know, continuing to encourage patients to have that usual source of care.

Jay W. Lee, MD 00:12:43 I think, what we know is that when patients do have a usual source of care, that really helps with, getting your care gaps closed, getting your vaccines done, getting your cancer screening done. and when you're not connected to a medical home or a team that's there to kind of help guide you through that. oftentimes that care can be very fragmented. And although we're in a very digital world, there's something, beautiful and classic and, about that analog relationship that you might have with your doctor, even if it's facilitated by digital, platforms. in the end, And it is that human connection that that makes us all healthier and all feel a lot more complete.

Austin Litrell 00:13:27 Absolutely. Great. I really appreciate you taking the time.

Jay W. Lee, MD 00:13:30 Yeah, 100%. and thank you for the opportunity.

Austin Litrell 00:13:34 Yeah. Thank you.

Keith Reynolds 00:13:42 Again, that was medical economics assistant editor Austin Luttrell and Doctor Jay Lee of the RFP. My name is Keith Reynolds. And on behalf of the whole medical economics team, I'd like to thank you for listening.

Keith Reynolds 00:13:52 And I ask that you please subscribe to the show on Apple Podcasts and Spotify. Also, if you'd like a digest of the best stories Medical Economics publishes delivered straight to your email six days a week, subscribe to our newsletter at Medical economics.com, medical economics, Physicians Practice and Patient Care Online are all members of the MG Life Sciences family. Thank you.