Podcasts

Vaccine Hesitancy and Allyship with Aysha Khoury, MD, MPH

In 2019, Dr. Aysha (i-sha) Khoury (koo-ree) was recruited to become founding faculty at Kaiser Permanente Bernard J Tyson School of Medicine. She developed case-based curricula, implementing flipped classroom and active learning pedagogies. She served as a small group facilitator and Equity, Inclusion, and Diversity Champion and Workgroup member. On August 28, 2020, within hours of engaging her small group in a critical discussion on bias and racism in medicine, she was targeted, suspended, and ultimately terminated without transparency or due process. We begin the interview by discussing her termination, what she felt led to it, although with the lack of transparency, she still hasn’t been informed. We use this as a jumping off point to discuss allyship, or in her situation, lack thereof.

We then move on to why there is medical mistrust among minoritized communities, including a discussion on why we now use words like minoritized and enslaved. We finish with a discussion on how to address SARS-Co-V-2 vaccine hesitancy in the setting of justifiable medical mistrust. Her argument is that there is less hesitancy in the older population, so if we address the inequities in vaccination access, the older population will be able to influence the hesitations of the younger population.

Dr. Khoury grew up in Atlanta, GA and completed her medical degree there at Morehouse School of Medicine. After completing an internal medicine residency and working as a primary care physician, she returned to Morehouse School of Medicine to complete training in public health and preventive medicine and earned a Master of Public Health.  After this, Dr. Khoury returned to the Southeastern Permanenete Medical Group and pioneered a new role there as a Clinical Decision Unit Internist. This encompassed work in quality management, process improvement, and evaluation of treatment outcomes. Committed to education and advocacy early in her career, she served as an adjunct clinical assistant professor and Admissions Committee Member at Morehouse School of Medicine, where she was later inducted in the White Coat Society for demonstrating compassionate care and community service.

Motivational Interviewing for Addressing Vaccine Hesitancy with Joseph Weiner, MD, PhD

Dr. Joseph Weiner is an Associate Professor of Clinical Psychiatry, Medicine and Science Education at the Zucker School of Medicine at Hofstra/Northwell, where he co-directs the four-year curriculum in Physician-Patient Communication and Interpersonal Skills. Thinking and writing about how patients and clinicians communicate with each other has been a major interest in his career.

He teaches us today about something I’ve been wanting to learn about for a long time. The tagline of this show is “everything we should have been learning while we were memorizing Kreb’s cycle.” This doesn’t hold true for this episode because Dr. Weiner teaches motivational interviewing to medical students; it just wasn’t being taught when I was there. We go over the basics of motivational interviewing, its origins, the spirit of it, how to go about it and then we discuss how it can be used to have a productive conversation about the SARS-CoV-2 vaccine. I haven’t had training in it, but I’ve used it already and it WORKS! You can’t use it to get someone to do something they don’t already want to do, but it helps them clarify their thoughts and hesitations and, using BJ Fogg’s language, either get closer to or over the action line.

Dr. Weiner received his M.D. and his Ph.D. in Physiology and Biophysics from New York University. He did residency training in psychiatry at NYU/Bellevue and a fellowship in public psychiatry at Columbia College of Physicians and Surgeons. In addition, he pursued advanced psychotherapy training at the American Institute of Psychoanalysis.

Dr. Weiner has received national and regional awards for his work as a clinician and educator. One he is particularly proud of was the 2015 Teacher of the Year Award from the Zucker School of Medicine at Hofstra/Northwell for the first 100 weeks of medical school. Dr. Weiner’s career interest in communication has expanded to the written medical narrative. He is writing a book about lessons learned from his late wife’s battle with cancer and is currently an MFA student in Creative Writing and Literature at Stony Brook Southampton.

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How Do People Make Decisions about Vaccinations with Reyaneh Maktoufi, PhD

Dr. Reyhaneh Maktoufi has recently defended her Ph.D. in Media, Technology, and Society at Northwestern University. She is a Rita Allen Foundation Civic Science Fellow at WGBH/NOVA. Her main fields of interest are science communication, misinformation, curiosity, public engagement with scientists, and science communication in media. She is a health communications expert turned science communication expert, so we are bringing her back into health communication with another discussion on addressing vaccine hesitancy.

When approaching patients with vaccine hesitancy, it is important recognizing that we make many decisions with emotions, not with facts. Fighting misinformation with information probably won’t. The key is trust. Find out the source of their hesitation and never ever dismiss it. Trust starts with relationship building and the conversation ends with addressing concerns. We also discuss how we can build trust in patients from communities that have justifiable mistrust of the medical establishment. And never bring up misinformation with your patients because it actually plants the seed of it possibly being true.

Before starting a Ph.D., Rey has been working as a health communication facilitator and cancer preventive/palliative care campaign manager in Tehran, Iran. She was a visiting researcher at the Adler Planetarium, where she studied science communication and facilitated workshops on communication skills and she’s also a producer at The Story Collider podcast. Rey currently enjoys working with different nonprofits such as the Communicating Science Conference (ComSciCon).

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Science Communication: SARS-CoV-2 Vaccine Edition, with Matthew Facciani, PhD

Matthew Facciani, PhD, is a postdoctoral researcher at Vanderbilt University in the Medicine, Health, and Society Department. His research interests include LGBTQ health, social networks, political polarization, and misinformation. We discuss science communication and how to find ways to make complicated science easier to understand. This is particularly relevant because of the SARS-CoV-2 vaccine, so we need to be sure we can effectively communicate how it works and any potential risks. We even get into how to effectively conceptualize and communicate risk. I fumbled during the interview to think of a quote from Neil deGrasse Tyson, which is “The good thing about science is that it’s true whether or not you believe in it,” but Dr. Facciani makes the point that even science is not without politics, so we discuss this and how because of politics, the traditional antivaxxer isn’t the same as the SARS-CoV-2 antivaxxer.

Dr. Facciani received a BA in Psychology from Westminster College and MA and PhD in Sociology from The University of South Carolina. Facciani’s writing and research has appeared in The Conversation, Snopes, Salon, Mother Jones, and other outlets. Facciani has also given talks about his research to audiences around the country and has provided scientific testimony to policy makers.  Find him at MatthewFacciani.com and his podcast Social Science Hour.

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Consent-Driven Care with Dr. Crystal Beal

Dr. Crystal Beal is a non-binary femme physician, who provides high-quality, expert, and individualized queer and #genderaffirming medical care through QueerDoc.com. QueerDoc’s mission is to raise the bar and lower the barriers to accessing #genderaffirmingcare. Dr. Beal discusses just how frequent trauma is and how what they call “consent-driven care” is an extension of #traumainformedcare. For more on trauma-informed care, see my episode with Dr. Megan Gerber.

As #physicians, we shouldn’t just assume that we have permission to touch our #patients in a way that we deem appropriate. We may assume that it is implied that if they are in the office for a thyroid exam, we can just examine their neck, but keep in mind, there may be a #traumahistory. They teach us at what point during the visit we should be asking for consent for parts of the #physicalexam and even the way we ask some parts of the history. This can help us #buildtrust with patients who may have had experiences with the #healthcaresystem that has given them cause for mistrust. We also discuss when it is necessary to have a chaperone.

Dr. Beal attended Florida State University College of Medicine. They completed their training at Valley #FamilyMedicine #Residency achieving Board Certification in Family Medicine. Continuing to see gaps in care for their #LGBTQ+community, Dr. Beal sought extensive additional training in #sexualhealth, #queerhealth, and gender affirming care including self-study, continuing medical education trainings, and shadowing experts at Seattle Children’s #GenderClinic.

While starting QueerDoc, Dr. Beal supported their #privatepractice through work providing care for people with #substanceusedisorder. Working in this field has continued to ignite Dr. Beal’s passion for #equityinhealthcare and advocacy for vulnerable populations. Now board-eligible in #AddictionMedicine, Dr. Beal plans to sit for the exams in 2021.

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Legal Issues Around Vaccines from Lawsuits to Mandates with Professor Dorit Reiss, PhD

Professor Dorit Rubinstein Reiss’ undergraduate degree in Law and Political Science is from the Faculty of Law in the Hebrew University of Jerusalem where she served as Editor-in-Chief of the Law Review. Increasingly, her research and activities are focused on legal and policy issues related to vaccines. She writes about school mandate, policy responses to non-vaccinating, tort issues and administrative issues related to vaccines. She is a member of the Vaccine Working Group on Ethics and Policy.

We discuss a lot of the legal arguments made by the antivaccine community, like the Vaccine Injury Compensation program, why the SARS-CoV-2 doesn’t actually apply and why it should. She also teaches us about mandates, exemptions and why the EUA status makes for dicey legal territory for a SAR-CoV-2 vaccine mandate. As someone who has been targeted and threatened by the antivaccine community, she also gives a lawyer’s perspective on responding to those threats. Given that she got into vaccines because of her children, it was fitting that they made a brief appearance.

Following graduation from law school, Professor Reiss clerked for a year and a half in the Israeli Ministry of Justice’s Department of Public Law, working on a variety of constitutional and administrative law issues. She received her Ph.D. from the Jurisprudence and Social Policy program in UC Berkeley, writing her dissertation on accountability in the liberalized telecommunications and electricity sectors in England, France and Sweden.  Professor Reiss’ initial research examined accountability of agencies at the state, national and international level, with agencies studied including the CPUC, the FAA, and other agencies in the United States and Europe.

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Cognitive Biases in Vaccine Decision Making with Jonathan Howard, MD

Jonathan Howard, MD, is double boarded in Neurology and Psychiatry and as he puts it in his Twitter profile, the author of several non-bestselling neurology textbooks. That’s not why he’s being interviewed. He also co-authored a book chapter entitled “The Anti-Vaccine Movement: A Litany of Fallacy and Errors,” in the book Pseudoscience: A Conspiracy Against Science and wrote his own book on fallacy and errors in medicine entitled, Cognitive Errors and Diagnostic Mistakes: A Case-Based Guide to Critical Thinking in Medicine.

We discuss some of the cognitive biases that people use when they decline vaccines, like the nirvana fallacy, anecdotal fallacy, and conspiracy theories. In some ways, the decision to vaccinate or not can be inordinately complicated, almost as if every step of the scientific processes needs to be vetted by each individual getting the vaccine. Our goal as physicians should be to ease the cognitive load of the decision-making, so we talk about how we can accomplish this.

Dr. Howard did his residency and fellowship at NYU, where he is now an associate Professor of Neurology and Psychiatry, specializing in Multiple Sclerosis. He is the neurology clerkship director and director of neurology at Bellevue. He can be found on Twitter at @JHowardBrainMD.

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Moving the Needle on SARS-CoV-2 Vaccine Fence-Sitters with Jordan Harbinger

Jordan Harbinger is a recovering Wall Street lawyer, turned podcaster. He’s actually been podcasting for longer than we’ve had smart phones. So why would I be asking him about vaccines? I’m not. We’ll get to that. His previous podcast and company focused on dating, but he realized that the skills that they were teaching regarding that specific social interaction actually applied to other aspects of life and so he pivoted his podcast and now his podcast really applies to anyone interested in personal development.

His expertise focuses more on entrepreneurship, networking and social engineer and that last one is the reason he’s on the show today. The decision to vaccinate may seem straightforward to some, but if you are considering all of the knowns, unknowns and unknowables, as many vaccine-hesitant patients tend to do, it can be inordinately complicated. As physicians, it should be our job to lighten the cognitive load of that decision and he is going to help us make sure we optimize any interaction with our families, friends, patients and communities.

His main point is that for many who are hesitant about the vaccine, they may just want to avoid making the decision. It is easier to sit on the fence, so we need to clarify that by not getting the vaccine, they aren’t deferring the decision, but deciding to not get the vaccine. We also need to press upon them that given that scarcity of the vaccine, but deferring now, it is unclear when they’ll have access again.

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Deep Listening – Impact Beyond the Exam Room, with Oscar Trimboli

Oscar Trimboli is passionate about using the gift of listening to bring positive change in homes, workplaces and the world. Through his work with chairs, boards of directors and executive teams in local, regional and global organizations, Oscar has experienced firsthand the transformational impact leaders and organizations can have when they listen beyond the words and he helps us bring this skill into the exam room. He talks about giving attention instead of paying attention, how to frame questions so they won’t be perceived as judgmental, how to utilize silence, and when it is actually ok to interrupt our patients!

Oscar is a marketing and technology industry veteran with over 30 years’ experience across general management, sales, marketing and operations for Microsoft, PeopleSoft, Polycom, Professional Advantage and Vodafone. During his time as a marketing director at Microsoft, he was accountable for the five-year journey to move Microsoft Office from DVDs to the Data Centre. He consults to organizations including 20th Century Fox, AstraZeneca, Google, HSBC, PayPal, Qantas, Reebok, TripAdvisor and Universal Music. He can be found at oscartrimboli.com and there you can find his podcast, Deep Listening: Impact Beyond Words.

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VRx: How Virtual Therapeutics Will Revolutionize Medicine, Dr. Brennan Spiegel

Brennan Spiegel, MD, is director of health-services research at Cedars-Sinai Medical Center, where he directs the Center for Outcomes Research and Education, which maintains one of the largest and most widely cited therapeutic virtual reality programs in the world. Spiegel is also professor of medicine and public health at UCLA. He wrote ACING the GI Board Exam, but he’s on the show today to discuss his book, VRx: How Virtual Therapeutics with Revolutionize Medicine.

Dr. Spiegel shows how a simple VR headset lets hospitalized patients escape the four walls of their isolation room to visit Icelandic fjords, empowers patients with schizophrenia to confront the demons in their head, offers dementia patients a new way regain function in a life-sized virtual town, and enables burn victims to manage their pain by traversing snowy virtual landscapes. Scientists are starting to uncover these surprising benefits, and not so far in the future, we may have doctors specializing in virtual medicine with its own ACING the VR Board Exam Review Book. In an unexpected way, VR is also strengthening the humanity in healthcare: vivid simulations of patients’ experiences can make us more empathic.

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