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Welcome to UAB MedCast, a continuing education podcast for medical professionals. Bringing knowledge to your world, here's Melanie Cole.

Melanie: Welcome to UAB MedCast. I'm Melanie Cole. And I'm so glad you can join us today as we talk about the psychology of vaccine hesitancy and how to beat compassion fatigue. Joining me is Dr. Michael Wiederman. He's the Director of Leadership and Professional Development in Family and Community Medicine at UAB Medicine.

Dr. Wiederman, I'm so glad to have you with us. And we were just talking off the air a little bit about how you decided on this topic, because I think that certainly medical professionals around the country and indeed around the world are facing this compassion fatigue and dealing with this vaccine hesitancy. So can you tell us before we get into it a little bit about yourself and how this topic came to be a podcast here?

Dr Michael Wiederman: Sure. So my background is clinical psychology. And, of course, in family medicine, so many of our providers, whether they be residents or faculty are really feeling sort of burned out, cynical sometimes, maybe even a little angry because, of course, the pandemic has been going on for so long that their compassion and energy is sort of well-worn as it is. And now to, you know, be treating patients, many times very serious cases of COVID and yet these patients have not been vaccinated, actually results in some of the sort of negativity that they're picking up on. So, they've been asking me for, you know, some different perspective on trying to understand their experience as well as the patient's experience.

Melanie: Well, I think this is not unique to the medical community right now, but I definitely think that it's more pervasive that they're exhausted, they're tired of trying to explain things. I mean, this has been going on a while now. So from a psychological perspective, let's start with the vaccine refusal or hesitancy. And I just want to put in my own sort of thing that I feel that it is a shame that something like this, a public health crisis, has been politicized. So now, if you would talk about the psychological perspective of why that's working and why that's happened, that would be great.

Dr Michael Wiederman: So, you know, I think about potential reasons that somebody is either refusing or hesitant around the vaccine and, to me, they fall into two broad categories. The first one is we might call sort of uncomplicated in the sense that it's based on maybe a lack of information or some misinformation, but that that misinformation isn't tied to any kind of identity or politicalization or anything like that. It's just simply a lack of information or misinformation. And then we have some folks who don't seem to be against vaccines necessarily, but they are ambivalent in the sense that perhaps they don't perceive themselves as having much risk or, you know, they have heard some of these negative things that are out there and they're not really attached to that belief system, but at the same time, it's like, "Well, I don't really feel like I'm at risk and maybe there are some negative things," so they just sort of coast along. And I wonder if for those folks, if we knocked on their door and said, "Hey, I've got the vaccine right here right now. Can you roll up your sleeve?" that we might get some of those folks to say sure.

So for that first category, I think we can approach those folks with rational information and sort of rational argument, if you will. And then for the second category, to me, it's really based on underlying psychological needs. And so as you were saying with the politicalization, is that if I feel like vaccine refusal is part of what my tribe or people like me do, then it's much more symbolic in meeting those sort of psychological or socio-political identity kinds of needs.

Melanie: Loyalty as it were, right?

Dr Michael Wiederman: Yeah, absolutely. And not only loyalty to the group, but maybe a loyalty to myself, that if I say, "I don't like to be told what to do. I have a high need for independence and autonomy. And the more you tell me, I need to do this, the more I'm actually going to dig my heels in," anything like that, it's not going to be productive to try to have a conversation based on facts and figures and information, because again, that's not what's lacking. And indeed those kinds of beliefs tend to also be unrelated or very, very weakly related to education. So it's not that these folks who hold those beliefs are less educated or less informed, again, I think it's sort of apples and oranges in terms of what's motivating those needs.

Melanie: So interesting. So we all hold our certain biases, right? Everybody does. How are these biases playing into this hesitancy? Now, you just mentioned some loyalty and whether or not it's just a belief or misinformation. But when we're thinking along a bias line, you've got these sort of divided up, right? Tell us a little bit about how this works in psychology.

Dr Michael Wiederman: Sure. When cognitive psychologists use the word bias, they often don't use it in quite the same way that we do in terms of a prejudice per se. But they mean that our brains are wired in such a way that we know the software leads us down certain pathways when it comes to certain kinds of thinking. So they've identified well over a dozen of what they call these heuristics and biases, ways that the mind is wired for all of us. So we're unaware of it happening because it's part of our cognitive software.

And so a great example of that is confirmation bias, which is once I hold a belief, I'm going to naturally and unconsciously seek and notice and remember information that fits my belief. And so, again, this is out of my conscious awareness, but it feels to me over time like I'm just more and more correct because the more I live or the more I seek information, it just seems to confirm what I already believe. And we tend to either ignore or distort or misremember or not remember disconfirming kinds of information. So confirmation bias is just one great example of how once we do hold some kind of belief around the vaccine, that it's just going to become stronger over time.

Melanie: Wow. What an interesting idea this whole thing is. So now along with this, and I mentioned this in the intro, the medical professionals around the country are experiencing compassion fatigue. And I think even those of us that are not necessarily working on the front lines are experiencing this as well. Can you expand on that? When we say compassion fatigue, what is it we're talking about?

Dr Michael Wiederman: Yeah. Well, if you think about compassion as I'm giving a part of myself emotionally, then, of course, we only have a certain amount of emotional reserves and those can be used up. And especially when the pandemic has dragged on this long, folks are already feeling compassion fatigue. And now, we're layering on an additional sort of strain in the sense that we have a vaccine, but people not taking it, it doesn't make rational sense to most healthcare professionals. And so therefore, it's just one more layer on top of the existing compassion fatigue that makes us maybe even a little more cynical or a little more persecutory, I guess, of folks who hold these beliefs or, you know, don't agree with us.

Melanie: Is there are difference between compassion and empathy?

Dr Michael Wiederman: I think many times compassion is based on empathy, right? That we can identify with this other person as another human being. And that doesn't mean that we need to even be able to understand where they're coming from, but we certainly recognize and empathize with their humanity and the fact that this a person and therefore I feel compassion, I feel care. And I think that's what's so difficult for healthcare professionals with this issue is that they want the best for their patients. And they feel like they're pretty certain what the best is, which in this case is vaccination. And yet people are thwarting their very desire to care for these patients and to be the kind of healthcare professional that they see themselves as and want to be.

Melanie: And in this instance, unlike we've seen really ever before, not only putting themselves in this position, but really putting their lives in danger in some respects both physically and mentally. I mean, there's a lot of it going around, right? And, at the beginning of the pandemic with the PPE shortage, it was pretty scary for medical professionals.

So as providers who want to talk with vaccine-hesitant patients, and you can give this advice to all of us really, or who are fighting this compassion fatigue, do you have any specific tips for these difficult conversations, ways that we can make our viewpoints known and yet hopefully break through what you described as some of the hesitancy reasons?

Dr Michael Wiederman: Yeah. I think again, for myself, coming back to those two broad reasons or categories of reasons is useful for me. So I think, "Well, is this person in category 1 or category 2?" If their hesitancy or refusal is based on those underlying psychological needs, then I try to remove my ego from it and not try to invest in talking them out of it because it's going to be frustrating for both of us, and recognize that this is something that is much deeper and larger than the brief visit that I have with this person or the conversation or the text message or whatever. And so trying to remove myself and at the same time, maybe just share our humanity. And I know that can be difficult sometimes as a professional, because we may feel like "I don't want to be vulnerable" or "It's inappropriate", so we need to do that professionally, of course.

But the idea of just sharing maybe our perspective or our story about all of this, our experience in terms of maybe saying something like, you know, "I can imagine that I might be coming across as very frustrated right now. That comes from a place of care because I've seen so many patients who are in dire straits, but they could've prevented it with vaccine. And so I just get very frustrated because it's really making a bad situation worse by, you know..." And so I'm sharing and doing that. I'm sharing my perspective. And it may have some impact. It may not. But at least, I think there's a greater likelihood than trying to be the rational information-giver or create a rational argument around the hesitancy.

Melanie: So really putting the onus on ourselves, instead of saying, "Why won't you? Why are you listening to a Facebook uncle? Or why are you..." Instead, we say, "I am just feeling this way because what I have seen is this." That's what you're saying, right?

Dr Michael Wiederman: Absolutely. Just trying to understand or at least share my story, my perspective. And then I'm also trying to understand the other's. So, one of the biases that psychologist have uncovered is what we refer to as the outgroup homogeneity bias. The idea is that any group that I'm not a part of is an outgroup to me. And I tend to see them as more homogenous than they really are. So if I see let's call them anti-vaxxers as a group, I tend to just sort of lump all those people together due to this bias and make all kinds of assumptions about their reasons and their politics and their education and all of these things.

And so just trying to understand and recognize that that's a bias I have just like they have a bias toward the medical establishment or, you know, healthcare professionals, they lump all of them as a group, because again, that's their out-group for them. So I might even flip it around and say, "I can imagine that it's difficult for you to understand how I can hold the opinions that I do. Is there anything that you've wondered about that or is there anything that I can share that might help sharpen your perspective about healthcare professionals?" And just trying to open that door for maybe a dialogue back and forth.

Melanie: That is so interesting. And as you say, we try and humanize even if we have that on our reverse side, that outgroup homogeneity bias, right? And putting them all, lumping them all into a group. What a lesson. I think we've learned from you here today.

As we get ready to wrap up, how can we apply these tips to other patient conversations or topics that patients might be hesitant about? Other vaccinations, preventive care screening's certainly a huge one. But while you're telling us that, include, if you would, if we hit that wall, if we hit that wall where they refuse to hear what we're saying, even if we humanize them, even if we put the onus on ourselves and tell our own stories, even if we've done all of that, then as providers, how do we step back or move away or turn them over to someone else? Kind of wrap this up for us with what we can do to bring this around to a whole healthcare situation and discussion and what we do if we can't.

Dr Michael Wiederman: Sure. So again, I think the underlying theme, like you said, for all of this in extension is this idea that we all have different belief systems. We're all coming at these kinds of decisions with different types of needs. And just because we, as an individual or as a healthcare professional, may see this as an informational issue, recognizing that for many people, there's a lot more going on in terms of psychological needs, social needs, barriers, those kinds of things. So trying to just simply understand their story, go into investigative mode and try to really understand it versus making assumptions and then trying to hammer away, convincing somebody based on those assumptions we hold.

And then as you said, what can we do when we sort of hit that wall? I think that's recognizing that you can only do so much. The patient has to meet you halfway. And I recall in my training a very helpful metaphor where a supervisor said, "We want to be responsible to our patients, but we can't be responsible for them." And so the way I took that was I'm going to do my best job to provide care and to meet you where you are, but I can't at the end of the day control what you do and certainly affect your health to the extent that I would like to. And so again, meeting them halfway and recognizing I can still take pride in doing a good job, because I tried to understand, I provided my side of the story, my humanity, but when they leave the office or leave the hospital, then it's out of my control..

Melanie: We can only do our best, right? And that's what we're here to do on these podcasts is to help to spread that word and educate other providers and so that they're learning from the incredible experts at the University of Alabama Madison. You guys really do inspire other providers around the country.

And I thank you, Dr. Wiederman, for joining us for this really great topic today. I think it's something that we all can learn from. That concludes this episode of UAB MedCast. Please remember to subscribe, rate and review this podcast and all the other UAB Medicine podcasts. I'm Melanie Cole.