Addressing Misinformation in Vaccine Conversations

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In “Beyond Diagnosis: Vaccines,“ Cleveland Clinic infectious disease specialist Donald Dumford III, MD, and host John Mangels explore how clinicians can communicate effectively and empathetically with patients when discussing vaccinations.

Each monthly installment examines an individual aspect of these crucial conversations, including building trust, responding to patient concerns, and navigating difficult or emotionally charged questions.

This second of six episodes focuses on addressing vaccine misinformation, setting realistic expectations about vaccine effectiveness and side effects, and maintaining rapport while correcting inaccurate or misleading claims.

The following is a transcript of their remarks:

Mangels: Welcome to “Beyond Diagnosis,” where we talk with doctors about talking with patients. I’m your host, John Mangels.

Today, we’re exploring one of the more challenging topics that clinicians face: speaking with patients about vaccinations.

Our guest is Cleveland Clinic infectious disease specialist Dr. Donald Dumford. He spends a lot of time navigating these dialogues; listening, building trust, and helping patients understand their choices. Dr. Dumford, thanks for being here.

Dumford: Thanks so much for having me.

Mangels: There’s no shortage of information out there about vaccines, but it’s fair to say the quality and the accuracy, that information varies pretty widely. What kinds of misinformation do patients mention most often when you’re talking with them about vaccinations?

Dumford: I’d say the biggest is that they think that the vaccine is going to give them the illness. I think that’s especially true during respiratory virus season with flu vaccines is that people think that the flu vaccine is going to give them the flu, when a lot of times it just so happens because of that time of year that they’re going to run into a different respiratory virus shortly afterwards, or sometimes just the side effects of the vaccine itself that is causing those symptoms.

And we have to remind patients a lot of times during these discussions that you might feel a little bit poorly the next couple of days after a vaccine, and we just have to remind them that’s actually the sign that the body’s immune system is starting to mount a response and it actually could be a good thing, in that if they actually get exposed to that virus or that bacteria, that when they do get exposed, they’re going to have a very robust response that’s going to protect them from serious outcomes, hospitalization, [or] death, most importantly.

Mangels: I’m guessing vaccines like the one for COVID or for RSV [respiratory syncytial virus] or shingles are pretty common things that you have to talk about and maybe knock down some of the misinformation about.

Dumford: Definitely. We see that often as far as when we’re talking with patients about those vaccines in particular.

Mangels: You talked about why patients might be feeling bad after being vaccinated, but with COVID, you probably are getting questions about, ‘Well, hey doc, I got the vaccination and then I got COVID.’ What do you say to them about that?

Dumford: Yeah, well, I just remind them that when we’re talking about some of these vaccines, the protection is good, but it’s not perfect. So I think we have to make sure with patient’s expectations that we set those right off the bat. In particular, thinking about COVID vaccination, flu vaccination, we know that their effectiveness is not 100%, and we have to let patients know that if they do get the illness after they get vaccinated, that the good thing is it’s going to make it less severe. They should have a shorter duration of illness, the symptoms that aren’t as bad.

And especially for the patients that are elderly or have other comorbid conditions, we have to remind them that it’s going to cut down their risk of really severe illness that could wind up with them in the hospital.

Mangels: So setting expectations, it sounds like is really a good thing to do at the outset.

Dumford: Oh, very much so, and I think that really helps patients out to understand exactly what the benefits are for those vaccines.

Mangels: When a patient references a particularly inaccurate claim about a vaccine, how do you address that while maintaining the rapport that you have?

Dumford: Well, I think the first thing is going to be just ask where do you hear that from? So you can sort of get a sense where they’re coming from. And then I like to kind of take what they’re saying and say, ‘I heard this.’ Let’s say in particular with COVID vaccinations, we’ve heard a lot about cardiac complications. And while that is true, I always remind patients that while we do see some cases of myocarditis with the COVID vaccine, we know that patients that are vaccinated are less likely to get those cardiac complications, and I also remind them that with those cardiac complications from vaccine, they’re usually very self-limited.

So that’s one example in particular, but I like to kind of take what they’re saying and what they’re telling me, and just inform them and let them know exactly what we know from the literature itself or from experience,

Mangels: Is it helpful to explore why a patient believes a particular piece of information, or do you focus more on reframing the discussion?

Dumford: I think it really depends on the patient. Sometimes you’d like to hear where they’re getting it from just so you might be able to, instead, give them another source that they may trust just as well. But I think a lot of times it’s more about the reframing for me.

It really is just, I think, individual to the patient, because especially for the primary care doctors out there or people have an ongoing longitudinal relationship with the patients they’re talking to, they’re going to know those patients well and kind of know whether to replace or reframe.

Mangels: That’s a really interesting strategy though that you might offer them, ‘Well, you might want to consider this as opposed to what you’ve looked at.’

Dumford: Definitely. I think as much as possible, we probably should try to lead patients to those reliable sources of information. As we’ve all seen the past several years through the COVID pandemic, that a lot of people when they say, ‘Well, I’ve done my own research’; maybe you could help to show them what a reliable source is, whether it’s going to the CDC website; New England Journal [of Medicine]; and JAMA and a lot of patient information pages.

So I think just kind of pick those out and have those in mind so you know how to replace what patients are going to and hopefully be able to direct them to a reliable source.

Mangels: Cleveland Clinic has a lot of good information on our website geared for patients.

Dumford: We definitely do. We do have a lot of good patient information in relation to vaccines and a lot of other conditions.

Mangels: Are there tactics that you use that kind of bring the temperature down a little bit? I imagine that things can get sometimes a little, if not heated, maybe defensive. How do you sort of lower that volume and that temperature?

Dumford: I really try to think about my nonverbal communications. In the office space, I’m typically already sitting, but if I’m in the inpatient space, I make sure I’m sitting instead of standing. You hear that from patients, or you even see that in research that shows if you’re sitting and you’re showing the patient that you’re present, you’re showing the patient that you’re taking time, which I think is really important with those interactions.

My favorite phrase is that ‘I am filtering this through the lens of this is what I do for myself, a family member, or a friend.’ I’ve found that that goes a long way for patients.

Mangels: That’s a great way of thinking about it, listening to yourself, how you’re communicating verbally and the nonverbal part too. You don’t want to be crossing your arms. You don’t want to be nodding your head the wrong way. Things like that, or frowning, I guess.

Dumford: And I think too that we all as physicians are very strapped for time. Those times, even when we are rushed, giving the impression that we’re taking adequate time is really important.

Mangels: Give the conversation some time to breathe, I guess. Right?

Dumford: Exactly.

Mangels: Can you recall a case where a patient brought up a concern that initially seemed implausible, but actually turned out to be a legitimate worry?

Dumford: Yeah. I’ve had several times both vaccines and non-vaccine treatment where patients will bring up a concern, something I may not have heard of before this, and maybe some potential safety concerns that they’ve heard about. When that brings up an apprehension of the patient to get vaccinated or other treatments for that matter, I use that time to pause and actually educate myself. That’s a time where I’m going to go to the primary literature, see how big of a connection there is, or if there was a connection at all.

And I’ve had times where I’ve actually been able to go back to the patient and said, ‘I went through several articles.’ Sometimes I’ll say exactly what sources I was using just so they kind of know that I was doing my due diligence. ‘I hear what you’re concerned about, but here’s why I’m seeing that concern you have is really negligible, and you’re going to have this potential benefit with proceeding.’

Mangels: So as we had said earlier, it’s really important to hear, to listen, and then to check yourself to say, ‘How do I know what I know as a doctor?’ and make sure that you’re on the right track.

Dumford: Right. I think actually it’s also very helpful for the doctors in that case. That’s sometimes when I’ve learned the most over the past several years, is when I am refreshing myself and relearning things that I learned a long time ago.

Mangels: Thanks so much for your insights, Dr. Dumford, and thank you for joining us on “Beyond Diagnosis,” where we explore not just what physicians know, but how to effectively and compassionately share that knowledge with patients. See you next time.

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