On March 17, ACEP’s Diversity, Inclusion, and Health Equity Section hosted the panel discussion “This Is Our Shot: How EM Docs Can Empower Patients to End the Pandemic.” Moderated by Tracy MacIntosh, MD, MPH, FACEP, this webinar brought together panelists Ugo Ezenkwele, MD, MPH; Pilar Ortega, MD; and Robert Rodriguez, MD, to discuss how historical abuses within the medical and scientific professions have led to modern-day mistrust and ways emergency physicians can compassionately address their patients’ concerns about the COVID-19 vaccine.

“These groups whose health care is centered in the ED are especially vulnerable to vaccine hesitancy,” Dr. Rodriguez said during the webinar. “[Emergency physicians] can become the trusted messenger for these populations.”

Here are a few key takeaways:

Avoid assumptions.

Dr. Ortega: We shouldn’t make assumptions about our patients because of the way they look or sound. We should be attentive to asking them, in a respectful way, about their background or language needs in order to ensure high-quality communication.

We may use terms like “vaccine hesitancy” to somehow set the blame on the patient for not getting the vaccine. It’s true there is this skepticism that is well-justified by historical injustices of these groups—that’s not to say that vaccine hesitancy is the reason that Latino or Black Americans aren’t accessing the vaccine. It’s much more about the access issues. Using this term to absolve the system of its own inefficiencies and inability to address the equity issues is not necessarily the appropriate approach.

Consider the patient’s unique circumstances.

Dr. Ortega: Among undocumented individuals, there are always underlying concerns about whether their private information may be reported to officials that would then put them at risk for deportation. We can be thinking through those obstacles ahead of time and eliminating them to make sure people feel that places of vaccination are a safe haven.

Acknowledge earned skepticism.

Dr. Ezenkwele: There is hesitancy in Black communities regarding any vaccine or any new therapy that comes out. There is a historical precedent here that I call “earned skepticism.” Emergency physicians on the front lines really have to acknowledge that.

Compassionate communication can build trust.

Dr. Ezenkwele: Let’s be real: Expecting you can erase or change some of the historical mistrust at the bedside may not be the right approach. The most you can do at bedside is listen to what the concerns are, ask specific questions, and acknowledge there is mistrust. You should try to answer their questions and share relevant information. You may not be able to erase the history, but you can start having the conversation.

Beyond the bedside, there are others in the community [patients] look up to. At Mount Sinai, we do community engagement. I’ve spoken directly to barbershops and churches. These are things we can do, as emergency physicians, to start turning back the clock on this hesitancy.

Make vaccine communication part of your routine.

Dr. Rodriguez: [Emergency physicians] can become the trusted messenger for these vulnerable populations. Do it on every patient. I’ve incorporated questions about COVID-
19 in all of my patient interactions now. If I see someone who has broken their arm, I ask about precautions, needs, have you thought about the vaccine, can we help you find a vaccine site? That has become part of my interaction. I’ve incorporated COVID-19 into my review of systems, past medical history—it’s become part of that sequence in every patient interaction. We are their primary health care providers, and you can accomplish a lot on both a global basis and an individual one-on-one patient basis.

GET MORE: The full webinar recording is free to all members within ACEP’s Online Learning Collaborative.