Let's Find Common Ground - How Should We Respond to the Vaccine Hesitant? With Dr. Jay Baruch

Episode Date: October 14, 2021

As an ER doctor, Jay Baruch has been treating Covid patients since the start of the pandemic. He still sees many patients sick with Covid in his ER - the vast majority unvaccinated.   It might seem reasonable for him to share the anger and frustration that many vaccinated Americans feel about the unvaxxed. While Jay wants everyone who is eligible to get the shot, he says judgment does nothing to persuade the hesitant to get the vaccine, and that there is a better way to respond. Jay is a Professor of Emergency Medicine at Brown University’s Alpert Medical School. He is also a writer. In this episode he discusses his desire for a more open dialogue about vaccination, one that involves listening to people’s stories, empathizing with their concerns, and recognizing that all human beings are complicated.

If you've had the shots against COVID-19, how do you feel about people who didn't get the vaccine? If you're holding off, what's your view of those who are telling you to get it? It's the subject of fierce debate as COVID-19 continues to rage in the US. Many people who've had the vaccine are angry and frustrated, berating the unvaxed as selfish, stupid, or both. But our guest on this show says there is a better way. This is Let's Find Common Ground. I'm Ashley Melntite. And I'm Richard Davies. Dr. J. Baruch has worked with COVID patients throughout the pandemic. He's an ER, doctor, and professor of emergency medicine at Brown University's Alpert Medical

School in Providence, Rhode Island. He's also a writer. Recently he wrote a piece for STAT, a new site about health, medicine, and the life sciences that went viral. J. would love everyone who can be, to be vaccinated, but he says there ought to be more empathy for those who haven't been. J. Baruch, welcome to Let's Find Common Ground.

Thank you very much. It's so really honor to be here. So J, you are an ER doctor and I think a lot of people would at least expect you to roll your eyes when you encounter unvaccinated patients in the ER with COVID. How do you actually feel when you meet these patients? Well, I think that inclination to eye roll is something that I wish I was a better person and say I'm resisting. I have the urge to roll the eyes, but I also Have learned in my I've been in your doctor going on 28 years now and what I have discovered

actually is that Oftentimes you we come in with certain opinions and certain biases and certain judgments and when you talk to The patients which is really just a person struggling you sort of understand like where they're coming from and biases and certain judgments. And when you talk to the patients, which is really just a person struggling, you sort of understand like where they're coming from. I often felt that people's reasoning were very complicated and very complex. And oftentimes it's very justified from their perspective.

And so I don't wanna come off saying that I don't roll my- that I don't have that urge to roll my eyes. I've got a very human being. However, I think I've gotten better at trying to sort of maybe stop the roll halfway around my socket and trying to understand a little bit like why, like the question of why. You've said that you don't judge people who have high blood pressure who come into the ER with a medical emergency. I guess there are lots of reasons why people end up in the ER and many are related to unfortunate lifestyle choices.

Yeah. related to unfortunate lifestyle choices. Yeah, and when we talk about that, I think it's really important to point out that oftentimes what we consider choices are not really choices that certain populations, certain people in our communities have. Like their choices are often between two bad choices.

Can you explain? You can talk about like quarterly controlled diabetes, like diabetes is really a terrible disease. And we're seeing devastating consequences of people with uncontrolled diabetes. And oftentimes they can't afford their insulin. The quote unquote non-compliant patient is someone who was trying to save her insulin dosages because she can't afford it or because the insurance company,

if they have insurance has changed and the pharmacy somehow doesn't have the medication that it's supposed to have, or they can't afford to have the foods where they don't have in their neighborhood, the place that they can readily get like healthier foods and they have to take a bus. They might not be able to ambulate and get around

as well as they should, or they might not have the social support. So what do you hear from patients who come to the emergency room with COVID? Well, last, like, have you been vaccinated? And sometimes they say no, and they don't last like, have you been vaccinated? And in and sometimes they say no. And and they're last like, what? Why? Like, and and it's it's very rarely. Is it a strong political statement? Sometimes

it's just shrug. Sometimes it's, I don't trust the vaccine. I don't trust the healthcare system. They developed this thing too quickly. I know it in their family has gotten it. I haven't gotten around with this apathy thing. Yes, I want to get it. It really gets a response that is like this very fervent, heated response. I would lump it under the topic of distrust, of information, distrust of the system, healthcare system. Jay, perhaps is there another factor playing out here, which is that it's easy for us to have a comfortable middle class lifestyle to ignore this, but for a lot of folks, they're just struggling day by day to get by. And it's not a question of planning or making the right choices. It's just dealing with whatever stuff comes their way and they're overwhelmed. And maybe that's

the reason why they didn't get vaccinated. One of my favorite books is novels. Let the Great World Spin by column again and he has a line in it, which I'll paraphrase poorly, which is something to be effective. It takes so much courage to to live an ordinary day. And I try to remind myself of that, you know, with the patients that I take care of, you know, because so many of my patients are struggling with so many other responsibilities and obligations. And yeah, I agree. I go, I think the COVID issue, the COVID vaccine issue, it's not a vaccine issue alone. And there's like the COVID problem, it's not a COVID problem alone.

I think it was the added pressure. It was the constant pressure in any sort of really complex story, which really unveiled or revealed challenges in healthcare and delivery of healthcare. That's been there all along. It's no longer a capable of being ignored. Following up from that, you had a beautiful thought in an article you wrote recently for STAT, which is the Health and Biotech news site. You said, we humans are beautifully flawed creatures with inexplicable needs and impulses that run counter to our best interests.

Discuss that. We'll just have our challenges that we're facing. best interests. Discuss that. Well, let us have our challenges that we're facing. Either big problems, small problems. And I think it's very easy from the outside to say, listen, you know, you shouldn't do this, don't do that. You know, an example that I use is like, I just just the other day, you know, I was talking with a patient who came in who had a very bad opioid problem who's been sort of in and out of treatment and has been leaving

against advice. And you know, we see, it's not an infrequent issue that we see with, with many of our patients. And obviously the easy thing for me to say is you should not do that. But like, just realizing that the hardest thing to do is to stop or to cut down. As I'm telling you this, I go, I'm someone who drinks way too much coffee. And I've been trying to cut down coffee for 20 years. But I also realize how hard it is to stop something that has ingrained into your life. And why we necessarily do the things that we do. But I do feel like we're privileged to have a choice, to be able to say, listen, I'm

going to do this. And this recognizes that certain people have stories where their choices are the sense of having control and to have an autonomous voice and to make a change. Even that assumption is one of privilege, especially for a lot of the patients that I take care of who really had a tough time right from the get-go. Some people listening to us talk about this might say, well, you know, they might hear what you're saying about your patients and say, okay,

I understand something that I perhaps didn't understand before. But, hang on a minute, these choices or whatever you want to call it that people who aren't getting vaccinated, they're selfish because they are putting other lives at risk. How do you respond to those people? Yeah, Ashley, I understand exactly what you're saying and what motivated me to write the piece for stat had a lot to do with the discourse we were having around vaccinations. I believe 100% you should get vaccinated. You know, my job has my job has become a very different job. I see the impact of the choices. I see

become a very different job. I see the impact of the choices. I see unconscionable weights and I see how healthcare is and delivery of healthcare is being impacted. You need to get vaccinated. I want everyone vaccinated or I want as many people as possible who are able to vaccinate, to vaccinate for COVID. However, how we get to this point, how we get those people to that decision, I feel that we had a narrative crisis. You know, I feel we were focusing so much on the science and so much on the numbers. When people were just trusting the numbers and they were just trusting the science. The headline of uroarticle was, it's easy to judge the unvaccinated.

As a doctor, I see a better alternative. What kind of response did it get? I got hit from people on the right, which I expected. I also got hit by people on the left, which I did not expect. But I had a lot of people who emailed me and reached out, and a lot of people who aren't vaccinated, who reached out. Of course, there were some people who were like, you're a terrible doctor eternal doctor and were kind of unkind, but I had so many people who were explaining why they're not vaccinated, like really lucid explanations. And they had to do with a little certain part of the country.

I don't have a doctor. I don't know who I can trust. I go on the internet. I read X, Y, and C sites, and I hear one thing, and then I go on to other sites, and I hear other things, and I don't know what to believe. People who are wearing masks and doing all the right things, but aren't getting vaccinated because of the fear, the fact that they've just got, they don't trust pharmaceutical companies. I had a lovely email, a long, beautiful email from someone who does research and says, like, I just think it went through too quickly and I just trusted.

And both these people say, I'm not political. Like, I'm not, like, I'm not taking a political stand. This is why I'm not getting vaccinated. And it seemed like they were just, they were grateful the fact that I was leaving a space for that. Like I'm saying, like I'm not, I'm trying to real open to the fact that there are other reason why people choosing not to get vaccinated. I also had a lovely correspondence with an old colleague of mine, another part of the country who said that she shared my article, the article with their mother

who hadn't been vaccinated and was reluctant to do so, who led to it led to a discussion and they got vaccinated. So, I have this idea about like respectful engagement, trying to understand the other person's perspective, not just trying to fill their information tank with what you believe is the good data, but actually try to engage with them and try to understand why. Like why? Because I don't think it's a

numbers issue, whether it's an identity issue, whether it's a trust issue, but I don't feel like we're getting there by sort of raising our voices. You think there's a better way to go about this. How do we do it? Part of it is, can we create these authentic spaces where engagement truly is the goal? Because I feel like when people sort of say, let's have a dialogue. It's like, I want to get you here so we can I can take my hammer and hit you over the head with what I believe and we know that people are never the thing that we think they are.

There's usually something deeper, but we just don't bother to dig. We don't bother to ask the right questions and I feel like we're so Right now, you know, as a populous, we're so focused on, we have this vaccine, we wanted to get this vaccine, now we got this vaccine, and now everyone just get this vaccine and let us move on. So I get it. I sort of see where people who perhaps, you know, are trying to trust, even if they wanted a looking to trust, they can find reasons that listen, I don't know. Then this is new technology that I've never heard about before. We should control the discourse and told the story and really made space for why people

might not want this. I think you're pointing to a problem with how we talk and listen to one another, which is that we're an either or society. Either it's good or it's bad. And we confuse discussion with debate. Perhaps we need more discussion and less debate. Yeah, that requires something that, you know, we're quite listening. And you know, when I mean listening, I don't mean just sort of like shutting up, but I once heard this definition for listening as, or willingness to have your mind changed. That's not just not talking.

That's actually really trying to sort of be in the moment listening to the person, trying to see what are coming from, bouncing that off of what you're thinking. Because these are hard things to voice. Like it's hard to articulate some of these really deep-seated issues, things that people are going through. I think what makes some of these discussions particularly hard

is, God, it forces us all to be vulnerable. I'm going to be open with you about why I'm, for example, why I chose not to get vaccinated, what I'm scared of. Really, what I'm going to be open with you about like why I'm, for example, why I chose not to get vaccinated. What I'm scared of, I mean, really it's like what I'm scared of, what am I fearful for? That's not just a different type of discussion. That's a different type of openness that I don't, I think we're moving away from, but which I think is desperately needed right now. You're listening to Dr. J. Baruch on Let's Find Common Ground. I'm Ashley.

And I'm Richard. We'd like to hear what you think of our show. It would be great if you could just do one of two things, or maybe both. First, rate and review, wherever you listen to podcasts that helps other people find us. And drop us an email. We're always open to your feedback, and we'd love to hear your ideas for future shows. You'll find us at podcastatcommongroundcommity.org. Now back to our interview with Jay Baruch. It was interesting when you mentioned that at least one person wrote to you and said, I don't know a doctor, I don't have a doctor.

I think again there's an assumption among many that everybody has a doctor and of course you trust your doctor. Right. When we get out of this and I have my fingers, my hands, my toes, my legs crossed that we get out of this and I, you know, I have my, my fingers, my hands, my toes, my legs crossed that we get out of this. And soon I feel like the next major step has to be, like a strong focus on what I think is the most important part of healthcare today, which is primary care. We need stronger primary care. We need to get more people going into primary care. We got to get more people going into primary care. We got to get people have people have physicians. And, you know, and obviously there's a health insurance issue. This points to larger deficits in our health care system that needs to be addressed.

And, you know, if there's ever a wake up call, I think this, this is it. People are dying as we're having these discussions. And people are leaving medicine and leaving healthcare as we're having these discussions. And I feel like there's an imperative to leaders, whether they realize or not, that if they think that we're going to go back to normal after this, people might be in for a very big surprise. So, Jay, let's learn more about your work in the emergency room and about your colleagues. During the height of COVID, you must have been scared or perhaps even a little terrified about all the suffering that was going on. You know, at the time, what was really strange, Richard, and I wrote a little bit about this,

is that I think I was more scared of COVID-19, just thing that we really know what it was when I wasn't in the hospital. You know, when I was homeless, worried more from my family, I was worried more from my friends. And despite the fact that lack of PPE was a big issue, the fact that we didn't really understand this disease, that was a big issue, but it was a sense of like, this is why we're in medicine,

like this is why we all signed up to be in medicine. What I realized is that I felt safest when I was actually in the ER because I was working with people who I really respect and I trusted and I don't just mean, you know, the doctors, I mean, the doctors, I mean, my nurses, I mean, the techs, secretaries, the people that we've been through, like the EAR staff is a strange thing that we work together, you know, and we see extremes of experiences day in night out all the time, you know, and they've seen me at my best. They've seen me at my worst. And I trust them like we've been through this. I trusted them inherently. And that sense of trust. In the sense that they were going to look out for me, they had my back. And I was going to have

their back. I mean, we came together. So maybe that's why I can't use the word necessarily terrified because I think we were just focusing on like, what we needed to do, you know, washing our hands, getting through the shift with our, with our, you know, N95, we were able to get them in our, you know, whatever mask in our face shields and gowns and trying to listen through all that stuff. It was just focusing on just getting through the shift. And now, what's happening with the people who were coming into the ER today after all these

months of dealing with COVID? People are sick, but people I'm caring for, I've never cared for as many people who have been universally sick with multiple problems, with sort of medical problems, top of social problems. So it's been escalating over 17, 18, 19 months. I mean, it's probably, even though I was those, you know, it was a little bit more anxiety about it back at the start, like the pressures now or something that I,

personally for myself, I've never encountered before. And then, you know, staff are leaving, you know, nursing is leaving. And so it's hard. How do you feel when people call you a hero for the work that you do? There are not a lot of people calling us heroes now. And even when they were at the first wave, I think I speak from many of my colleagues.

And we didn't feel like heroes. We were just doing the work that we were always doing. And we always talked about, you know, we'd always ask each other like, you know, how you doing? And once I'm a nurse who I love said to the, she goes, Hey, Jay, how you doing? And I'm like, I'm like, all right, I go, how you doing? And she goes, okay. And they were like this silence. And she looks at me and says, you realize that when people say that you're not doing okay, they're not doing okay. And I go, I know. But we laugh about it, but part of what we were trying to do is create some of these

spaces where people could truly talk about it, about these things. And I think we all have our defense mechanism and we laugh a little bit. There's some of this little bit of gallows humor, so to speak, but I think for many of the experiences of my colleagues that if they didn't laugh about it, I think they'd cry all day. Going back to the question of the unvaccinated, what can we do about this?

Jay, you say we need to create spaces where we can hear each other's stories. So what could that look like? That's such a great question. I'd love to hear from listeners and what they, and what, how they envision this, this may go. And I feel like the question that you asked actually requires us to address a few things, which is one is that I think people, you know, really come into this from, come into as many different issues with, with their opinions and being able to sort of set the parameters for like listen, this is about,

this is about sort of having a different type of discussion and being open to that. And what I have discovered is that all the times when we, when we enter these spaces, there are people expect to be sort of spoken to, are they coming with a certain preconception of how it's gonna unfold? Because there really aren't a lot of models for these types of discourse, right? I think certain people get it. Like certain people, I think understand,

and I think people on the left end and the right, I think there are people who hold certain views. I don't think it's a left or a right thing who are really want to sort of understand what the other sides are thinking and they're willing to entertain what other people are thinking and maybe not agree. I respectfully disagree. I understand what you're saying, why you're saying it.

So how do we go about doing this? One is, I think we have to be modeled. I think we're making an assumption that people necessarily know how to do it, especially now when amplification and voices and likes are polarized. It's not really a good thing to elevate yourself as someone who loves the messy middle. Like, I love the messy middle. I think that's where we have such really interesting discourse. And what I've learned at least from the people who have responded to me, many of them, majority of them were like, essentially,

we're like, I'm so glad you're inviting us into the messy middle. I would be great if there were just opportunities that people have with their family and their friends and say, listen, let's do this. Let's talk about this because I've learned that there are families who are anger or just polite discord,

because some people are backstage and some people are unvaccinated, and they live together. They're actually multigenerational homes, which I've learned. I think if we get permission, and first we'll get permission to people and say, listen, this is okay to have these discussions, and we're just not having that. So one is like giving permission to people to say, listen, this is okay to have these discussions. And we're just not having that.

So one is like giving permission to people to, how can we model that and what is, how can social media, how can podcasts like common ground and organization to come ground, conserve and supporting this type of discourse. But also, how do you get people who perhaps are not thinking this way to actually enter this space? But I love it when people are trying to make a gesture, the idea of struggle. We don't have the answer. I'm struggling to try to understand this because we have to do that. So one is, I think, local level families, the kitchen table, local community organizations,

to actually modeling that whenever possible and that can happen to local level or a larger level. Three, I think social media has to find a way, you know, and part of it is going to be sort of in the algorithms in which what it feeds us, because it feeds us the things that we want to we want to hear. But I think there has to be a different way in which we create a different arena where perhaps it feeds different things around the same topic that will allow us to sort of see different perspectives. But the spirit has to be one of openness.

And you truly, truly, truly want to know what people are thinking and what they're saying. And you're not just trying to sort of like, I'll do a big switch, which come here, and I'm gonna hit you over the head with numbers and data, and I'm not really trying to understand why, why you're not getting vaccinated. Jay-Baruch, thank you so much for joining us on Let's Find Common Ground today. This was an absolute thrill,

and I thank you very, very much for having me. It's good to have the doctor in the house. Exactly. Don't be rich, thank you Ashley. Jay Baruch on our website will link you to the article he wrote for Stat that led to this interview. You'll find it at commongroundcommittee.org slash podcast. Let's find Common Ground as a production of Common Ground Committee.

Our team includes Eric Olson, Bruce Bond, Donnerfist Lockhe, Mary Anglade and Isabella Moore. Our producer is Miranda Schaefer. I'm Ashley Melntite and I'm Richard Davies. Thanks for listening.