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“Exploring the Intersection of Patient Autonomy and Vaccine Skepticism in Medical Practice”

Biel.- [residente del primer año de Medicina de Familia] How are you here, Esther, at the health center?

Esther.- [residente del tercer año de Medicina de Familia] Boy, I just can’t stand the rotation around the hospital. I’m looking forward to finishing R3 to return to the center. And I have seen that today there is a session on vaccines, ethics and patient autonomy, so I have come to see if I can learn something practical.

Biel.- [saca el teléfono y lee en la pantalla] “I find myself crying many days when I leave the hospital, absolutely frustrated with the medical institution. I see supremacist medicine, which in my opinion does more harm than good, a lack of common sense, knowledge, important humanity and ethics, technocracy, unnecessary interventions , irreparable damage, moral superiority, competitiveness with peers, classist, racist and sexist doctors, and patients who thank the doctor for helping them with that erectile dysfunction that was the result of that little-needed intervention, while the doctor later comments on what she will need, to that age, make use of their sexuality”.

Esther.- [entusiasmada] Yes, yes, exactly that. Where did you get it from, a Family R1 like you, almost new to “real life”?

Biel.- Well, I am enrolled in the SIAP Asturies, on patient autonomy, and I have found it trying to find out how that rock retains the desire to live, work and change without burning out. You may like it.

https://www.espaciosanitario.com/opinion/el-mirador/como-habeis-aguantado-tantos-anos-sin-perder-fuerzas-y-manteniendo-la-alegria_1535230_102.html

Esther.- And what is a SIAP?

Biel.- An experience of inverse pedagogy, of collaborative knowledge construction, where everyone has something to teach and a lot to learn, where you learn what you need to know in the clinic, but they don’t teach you either as a student or a resident, where there are “science, conscience and courage”.

https://www.espaciosanitario.com/opinion/el-mirador/todos-tenemos-algo-ensenar-mucho-aprender-conocimiento-colectivo-pedagogia-inversa-sin-brecha-genero_2005715_102.html

Esther.- Well, that seems important! And have you discussed the theme of the session, about autonomy and vaccination?

Biel.- Well no, but there is a clinical case, number 4, that I would have liked to take as a speaker, but I did not dare, it is the first SIAP in which I participate.

Esther.- Will you pass me the link, please, to sign up.

Biel.- I’m sorry, the deadline has closed, we’ve been having a virtual debate by email since May 3 that consumes me almost an hour a day just reading it.

Esther.- [Lo mira como sorprendida, valorando su saber, y lo apuesto que es “aunque quizá muy jovencito para mí”] And you, how are you aware of these things?

Biel.- [Ruborizado, se ha dado cuenta de la mirada atrevida de Esther] It’s that I was a member of IFMSA (International Federation of Medical Student Associations) during my studies, and also of Farmacríticxs, so I am aware of the “other world”, of “worthwhile medicine”.

Esther.- Well, let’s see if you can update me! Do you have guard this weekend? If you want, we can go to my town, my grandparents would take great care of us…

Biel.- [“¡Caray, esta Esther va lanzada… !”] Ok, I would love to. I change the guard and so we can spend the weekend in your town…

Esther.- And several neo-rurals now live there, in a commune, and they don’t vaccinate their children, so we can talk to them and find out why!

Biel.- I have read a text about “natural life, natural medicines”, just from a rural commune, and a case of whooping cough in an unvaccinated person. https://rafabravo.blog/2011/12/21/vida-natural-medicamentos-naturales/

The #siapAsturies insists on compliance with the Patient Autonomy Law, which is already twenty years old and obliges us professionals (“the rights of patients are obligations of professionals”, they say). In case 4, a nurse vaccinates a patient for flu that she goes to see at home to give him the monthly injection of vitamin B12. Of course, the truth is, I don’t know why she is going to give him the injection because the oral route may be enough.

Esther.- Do you think that the oral route in vitamin B12 supplements could be enough?

Biel.- Well, they did a clinical trial in Madrid, in primary care, and they proved it. https://bmjopen.bmj.com/content/10/8/e033687?rss=1

Esther.- Wow, Biel! You are amazing me…

Biel.- [De nuevo ruborizado] I already told you that it is something that interests me. In clinical case 4 at #siapAsturies, the nurse gave a patient the flu vaccine at home without the authorization of her guardian, who found out about it and is willing to report the matter. On top of a failed vaccine!

Esther.- Do you think the flu vaccine is useless?

Biel.- Well, I don’t think so, they are publications of the Cochrane Reviews

https://community.cochrane.org/news/why-have-three-long-running-cochrane-reviews-influenza-vaccines-been-stabilised

And, on top of that, it has adverse effects, some serious. I don’t think it’s an essential vaccine. Another thing is the question of incentives to vaccinate all the elderly, which is said to be an indicator… I don’t know. I know the nurse, Cristina, but it seems to me that in this case the best thing is for her to apologize, and for her to explain that she didn’t think of it.

Esther.- You would do it?

Biel.- Yes, I think we have to know how to ask for forgiveness and try to repair the mistakes, because we can be wrong, and Cristina has been wrong in this case. The end doesn’t justify the means, so she would have had to get the guardian’s okay even if the flu shot was worth it.

Esther.- I don’t know. Management does nothing but insist on vaccinating and vaccinating, against covid-19, the flu, herpes zoster and everything. Don’t you have to comply with these rules? Vaccines are always good!

Biel.- Not all vaccines are the same, there are vaccines and vaccines, what the NoThanks say https://dempeusperlasalut.wordpress.com/2015/08/23/editorial-nogracias-vacunas-no-todas-son-iguales/

Those rules that you mention are nothing more than suggestions, and professionals have to apply their good judgment in each case, and always respect the legislation, including the Patient Autonomy Law. In addition, vaccines are medicines and their rational use must be promoted. What would happen if, precisely in this case, a serious adverse reaction occurs, after having vaccinated without the permission of the guardian?

Esther.- I don’t know. Let’s see what they tell us in the session. Aurora and Belén carry it, right?

Biel.- Yes, yes, it sure is interesting. The two oldest and wisest, medical and administrative, complement each other very well. They are sensible and calm. Surely they help us to respect the autonomy of the patient and to know how to dialogue with those who have skepticism and doubts about vaccination, which is a problem partly related to the excesses and damages of the health system We cannot go imposing truths, people have their own beliefs and their own values ​​and we only accompany them and witness their lives.

Esther.- [Abriendo ya la puerta de la sala de sesiones] Very well said. I’ll call you on Friday to meet. I already have the car and so we can leave that same afternoon. OK?

Biel.- [Rojo como un tomate, pensando “aquí va a haber más que palabras…”] Yes, yes, delighted by me. I’ve liked you since day one…

Questions for discussion:

1/ Have you had patients who have expressed skepticism and doubts about the vaccine?

2/ The fact of refusing to be vaccinated oneself is different from that same woman refusing to vaccinate her daughters. How is it different?

3/ Do you have arguments to defend, or understand, Cristina, the nurse who has vaccinated for flu without permission from the guardian?

USE

This case is part of the set of clinical cases of the #siapAsturies Satellite on “Patient autonomy. In the consultation and always, with patient shoes”

https://siapasturias2023.wixsite.com/siapasturias2023

Case 4. Vaccination and autonomy

The relative and guardian of a patient consults me, denouncing that the nurse has vaccinated his uncle against the flu without his permission and taking advantage of the appointment for the monthly injection of vitamin B12. The nursing clinical note states “verbal authorization of the patient after a telephone call”, but the authorization of his guardian does not appear.

2023-05-28 08:00:00
#Patient #autonomy #case #vaccines #vaccination #JuanGrvas #MercedesPérezFernández #ElMirador #Vacunas #Vacunación

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