Trust, Faith, and Covid

A professors perspective

In a recent “Perspective” article in The New England Journal of Medicine, Trust, Faith and Covid, Professor Eve Rittenberg writes about the acceptance of the faith of some patients, or so it seems. Rittenberg, from Harvard no less, attempts to deliver a story of her empathic stance with an unvaccinated patient. I can appreciate her wanting to maintain and open and honest relationship with her patient and honour the patients faith in God. But I feel the whole piece is set up to reiterate, yet again, how “safe and effective” the vaccines are, how misled the vaccine hesitant are, and what heroic efforts the medical profession are taking to save everyone.

Harvard, as you may know, are huge recipients of funds from Big Pharma and have a long history of such. So I was drawn to the article “Trust, Faith, and Covid” wondering if such an institution was saying anything meaningful about faith and covid. Well there might be a token admission that faith has a place in strengthening a person, but not sufficient to fight covid. This was about “the power of science” verses the power of God…

This time I hesitated. I find it harder to disagree than to empathize, and in my nonprofessional life, I avoid conflict whenever possible. But my work requires disagreement and persuasion, in fact centers on motivational interviewing as I try to counter what my patients are hearing in the media or from their families and friends. Each day, I encourage someone who is reluctant to take a medicine to treat their cholesterol or osteoporosis, or I refuse to prescribe hydroxychloroquine for Covid-19 or a narcotic for chronic pain. Each time, I think about how to persuade without losing trust.

Rittenberg has to counter what her faithful patient is hearing from media, family and friends, refuse to prescribe hydroxychloroquine, and try to persuade without losing trust. Like all good propaganda you should always set up the thing you want to destroy with an extreme analogous example: refusing narcotic for chronic pain; refusing hydroxychloroquine for Covid-19. The good doctor knows best and the stupid patients would kill themselves if left to their own devices.

I knew that Ms. G. had not yet been vaccinated against Covid. And I have seen so many people sick, have read the literature documenting the vaccine’s incredible efficacy and safety, have rested my belief in the power of science. But Ms. G. poured out the reasons she didn’t believe in the vaccine: it doesn’t work against the variants, if you get the vaccine you won’t wear a mask, and more. Most important, God would keep her safe. She didn’t need this vaccine.

The good doctor knows the literature (obviously not all of it, probably only the Pfizer sanctioned Harvard studies) and knows the vaccines have “incredible efficacy and safety”, and counts her “belief in the power of science”, as somehow more in the know than her patients faith in her God to keep her safe. Is the “power of science” greater than the power of God? Seems so. And “safe and effective” is now “incredible efficacy and safety”. Oh and another tip for the budding propagandist - when stating a legitimate concern, marry it with a stupid or frivolous one, to diminish the legitimate one: i.e. coupling “vaccines don’t work” with “won’t wear a mask” in the wonderful example above, thus diminishing the value of the non-working vaccine statement.

I considered how to honor her ability to make choices about her health without abdicating my role as a source of medical expertise. Reciting the facts, I described the minuscule risk of a serious adverse effect from the vaccine, versus the significant risk of Covid, but Ms. G.’s skeptical expression was easy to recognize even above her mask. And so I told her that I respected her beliefs, and I reflected back her earlier assertion that she would do her part to stay healthy. I told her about my experience getting vaccinated and asserted my belief in the vaccine’s efficacy. I asked her to think about it, because I wanted the best for her, wanted her to stay safe. I tried to plant the seed for change.

Rittenberg “recites the facts” of “minuscule risk of a serious adverse effect” and the “significant risk of Covid”. Her belief in the vaccine had to trump her patient’s skepticism and faith in God. The good doctor plants seeds for change as all faithful disciples should. And a few more good propaganda tips here - throw in the idea that the doctor actually wants to honor choice, when there is nothing that actually resembles choice in the current climate (unless you count all out hand-to-hand bloody combat with the medical profession and the government to avoid the jab as a choice). And then throw in how responsible the doctor is being by not abdicating her role as a “source of medical expertise” (even though she’s only read one perspective in the literature, must have alternative explanations for those dropping dead or severely injured within 24 hours of the jab, and is blind to the biggest propaganda campaign the world has ever seen).

I have had similar conversations, over and over, with patients who don’t want to get the Covid vaccine — about their mistrust of medical institutions and providers, of science, of politicians; their feeling of being pressured; and their fear of being harmed. One distraught young woman had been warned by her family that the vaccine would make her infertile. And I think about the racism and misogyny that have so often shaped medical care in our country, and the ways in which such experiences color our relationships and our individual decisions about our health.

Here the legitimate concerns of other patients is presented as just a gross misunderstanding of the true nature of things. Rittenberg throws in racism and misogyny as culprits of such misunderstandings - but maybe she feels it wouldn’t be a legitimate articles if there was no mention of racism? I think it’s another good learning moment for the young propagandist - always throw in a parallel, but not necessarily relevant piece of evidence for causality, that doesn’t actually cause the thing you say it’s causing, but has enough history and weight behind it to give the impression there’s a very strong causal element (and it’s just confusing, which is always a bonus). It is encouraging, however that the good doctor is having these conversations “over and over” with those not wanting to get the covid vaccine - a good sign indeed.

No matter how much I want to convince Ms. G. to get vaccinated, I know that in medicine, relationship and trust are fundamental to healing. I uncomfortably juggle these two conflicting imperatives and try not to let my frustration turn into anger. And so I stepped back to let Ms. G. think about what to do next. After our visit, I sent her this essay, with the hope that we might, together, navigate this collision of persuasion, faith, and trust.

I totally agree that “relationship and trust are fundamental to healing” (the good doctor is good, don’t forget that) but being on the edge of frustration turning to anger belies a deep seated belief in the final solution - the jab. But, like an adult with a wayward teenager, the good doctor is stepping back so the patient can “think about what to do next” (I’m imagining the doctor with her hands on her hips watching the patent leave and giving an ever so slight shaking of her head). And like a parental collision with a teenager, the doctor wants to navigate the triune positions of persuasion (I’m right, I’m the professional), faith (your faith in God is misguided, I don’t think God has read the literature), and trust (you must trust “the science”).

At least at the end the dialogue felt for the doctor “meaningful and therapeutic”.