For some patients, statistics may be a helpful tool, noted co-moderator Chris Phillips, MD, of Paducah Rheumatology, Kentucky. For example, Dr. Phillips said he might contrast the small risks of thrombosis from the Johnson & Johnson vaccine with the much greater risks of mortality from COVID-19, using specific numbers. “Sometimes I think our patients … misvalue how likely those things are to happen, so trying to recenter that is sometimes helpful,” he said.
ACR President David R. Karp, MD, PhD, chief of the Rheumatic Diseases Division at UT Southwestern Medical Center, Dallas, remarked on a particular concern that many rheumatology patients have: the risk the vaccine may trigger a flare. “I tell patients that if you have a flare [after a vaccine], we can treat you, but in the meantime, you are protected from a disease that is deadly. Thus far, thousands of patients with rheumatic and autoimmune diseases have been vaccinated and have done well,” Dr. Karp said.
Sometimes, clinicians feel an urgency to get their patients vaccinated as quickly as possible, Dr. Manning noted. But by trying to understand patients’ specific concerns and gently and repeatedly bringing up the subject, clinicians may gradually make an impact. “Yes, there is urgency when it comes to being vaccinated for COVID-19, but if you don’t keep trying to plant the seed and keep the trust open, we definitely aren’t going to get there,” she said.
Irene Blanco, MD, MS, a professor in the Department of Medicine, Albert Einstein School of Medicine, New York City, and co-chair of the ACR’s Diversity, Equity and Inclusion Subcommittee of the Collaborative Initiatives (COIN) Special Committee, noted that rheumatologists regularly engage in hard conversations with their patients, especially those who have complicated diseases. “How do we keep those conversations going?” she asked.
Dr. Manning said it’s important to approach all patient questions directly and in a non-patronizing way. For example, ask a patient concerned they might be microchipped when getting the vaccine what they think that could mean. Don’t pass judgment, but continue to ask patients respectful, but probing, questions. “Particularly when there is not racial or cultural concordance or there are some areas where there isn’t trust, judgment could close the door, and you want to keep the dialogue going,” she said.