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Crack the Case: Strategies to Promote Vaccine Confidence

Listen to “Crack the Case: Strategies to Promote Vaccine Confidence” on Spreaker.

October 4, 2024

In Minnesota, we are currently grappling with yet another measles outbreak, a danger that is entirely avoidable with adequate vaccination rates. This is the reality of a post-COVID era defined by politicized basic health care and well-funded anti-vaccination groups striking fear in well intentioned parents. Indeed, conversations with vaccine hesitant parents can be some of the most challenging in our work as pediatricians, taking not only time in tight schedules but also extreme patience and resolve. This episode’s cases will explore evidence-based communication strategies to address vaccine hesitancy released by the AAP earlier this year. With the help of vaccine expert Patsy Stinchfield MS, CPNP-PC, we’ll also delve into public health interventions to consider for our current outbreak.

Transcript

Dr. Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts, where the complex is our every day. Each episode, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge, and perhaps change, how you care for kids.

Welcome to Talking Pediatrics. I’m your host, Dr. Kade Goepferd. On our Crack the Case segment, we take real-life patient cases that present to a primary care setting and dissect medical decision-making, evidence-based guidance and associated clinical pearls. It’s a case-based journey of a diagnostic dilemma with Dr. Bryan Fate that also includes some custom music to aid your medical memory.

Dr. Bryan Fate: Welcome to Crack the Case. Today’s episode will dive into vaccine hesitancy, evidence-based communication strategies clinicians can put to use, as well as some public health underpinnings on the issue to be more familiar with. I’m Dr. Bryan Fate, a general practitioner at our Minneapolis clinic, and with me today is Patsy Stinchfield, pediatric nurse practitioner and living legend in the field of vaccine preventable disease. Welcome, Patsy.

Patsy Stinchfield: Thanks for having me.

Dr. Bryan Fate: Though semi-retired, Patsy is currently the immediate past president of the National Foundation for Infectious Diseases, and was instrumental in leading the charge against not only COVID-19, also H1N1 and the 2017 measles outbreak as incident commander of Children’s Minnesota. Patsy, it is truly an honor to have you on today. You are the mayor of Children’s Minnesota, as evidenced walking here. Though many of our listeners likely know you already, what are one or two autobiographical facts outside of medicine that may surprise them?

Patsy Stinchfield: I think very few people know this, that I finished nursing school when I was 22 and got my BSN, got married in August, and in September moved from Minnesota to Memphis, Tennessee with my husband, who was going there for grad school. I wanted to get a day job so we could see each other, and I got a job as a school nurse and a health careers teacher in a high school that was 100% African-American students, faculty, administration. I was the only White woman in this giant school, and there was only one other White person, who was a male custodian, and he didn’t care for me too much. He called me a Yankee regularly. It was a great, great experience, to be a minority, and to have these kids just love, me and I loved them, and was there for three years. I have lots of great stories from that experience, but not enough time today.

Dr. Bryan Fate: Amazing.

Music:
Got to crack the case with Dr. Fate.
Crack the case with Dr. Fate.
Crack the case with Dr. Fate.

Dr. Bryan Fate: To introduce the topic today, we’re talking about vaccines, which, as we all know, are safe, incredibly well researched, and have saved more children’s lives than any other public health intervention of the last century. Typically, I wouldn’t lead with super obvious facts, but unfortunately, we live in a time where vaccination, even science itself, has been politicized along red and blue lines. Anti-vaccination groups are well-funded, highly organized, and get to play by their own set of rules, foregoing evidence for highly emotional appeals that grip at a parent’s worst fears. As a primary care pediatrician, I would argue that the most important orders I place are for vaccines.

Patsy Stinchfield: I love that.

Dr. Bryan Fate: It’s true. With the contextual factors noted and the infinite corridors of the internet, however, the opportunity to protect from diseases like measles and meningitis is not always matched with similar enthusiasm. Indeed, conversations with vaccine-hesitant parents can be some of the most challenging of my work, and of my colleagues as well, taking not only time in tight schedules, but also extreme patience and resolve. When these discussions surpass double digits in a day, I feel like a boxer that would prefer to stay on the mat, though I’ll keep getting up. Fortunately for us today, there are some evidence-based communication strategies to help frame these discussions for success. And then, with Patsy today as our expert, we will explore some of these recommendations issued by the American Academy of Pediatrics in March, entitled Strategies for Improving Vaccine Communication and Uptake. We’ll also zoom outside clinic walls to hear public health pearls in addressing vaccine hesitancy from Patsy’s extensive experience.

To present our cases today, our first case is Nazareth Reed Walker, a healthy 12-month-old in clinic here for wellness checkup. Growth looks outstanding, Nazareth is already walking, and family has gotten overwhelmingly positive responses from friends about their decision to honor Timberwolves star Naz Reid with their name selection. Go Wolves.

As the visit is wrapping up, the pediatrician commends Nazareth’s outstanding growth and development, and discusses hemoglobin, lead screening, along with dental varnish. After pausing at the door, the visit is concluded with the question, how do we feel about shots today? Nazareth’s mom responds that she would like to wait until he’s talking more, as a friend’s daughter stopped talking after receiving the MMR vaccine. The pediatrician replies, “Well, I’d recommend Nazareth get his vaccines, but let’s keep talking,” closes the door, and the visit concludes.

Patsy, I was hoping we could get your feedback on this pediatrician’s communication strategies. How could they potentially change their approach based on the AAP recommendations?

Patsy Stinchfield: Lots to talk about here. I give them points for liking the Naz Reid name, and building a relationship there, having some personal moment together. That’s where the trust building starts, is something personal. I always do that. Before I get into anything clinical, find something just fun that you share with each other. Talking about their child’s name is certainly one of them, but it goes downhill after that. I think what we would consider, this is a 12-month old in a time of potential measles circulating who leaves the clinic unvaccinated, we would consider this a missed opportunity. This is a big problem. One, the pediatrician does not seem to have a sense of urgency about measles. “This is a 12-month-old, this is your first opportunity. I’m so glad you’re here. We’re really going to get this going to protect you, because it’s in our community.” You don’t get that vaccines that are prioritized, because it’s on the way out the door, and the door is shutting, and, “Oh, by the way.”

Parents pick that up, like, “They must not value this.” The word feel, how do you feel about vaccines? Do we ever hear a cardiologist saying, “How do you feel about open heart surgery?” We don’t. Where we’ve gotten is, social media pulling us, and we need to pull that back, and lead that conversation not with feelings, but with strong statements. Ones that are evidence-based, ones that come with clear confidence, and even in how you’re talking, you have looked at the chart before you went in the room, you know exactly what they need. You’re not with your back to the patient, fumbling through their chart, looking through their electronic medical record. You have a kind, caring voice. You are looking them in the eye. Your shoulders are square, and you have your presumptive statement of, “Your child is due for three vaccines today, and because it’s almost Halloween, we’re going to add influenza, so by the time Thanksgiving comes, he’s all protected.”

Boom. It’s a statement. They have selected you as the pediatrician. The presumption is, you’re the expert, and we’re going to presume to be on the same page as far as following vaccines. Those statements really need to be clear, not a question, and try to develop that quickly and right off the bat, so they know that’s what they’re there for.

Dr. Bryan Fate: When I think about it, I think about presumptive language as essentially just telling families, “This is as common as checking your height, weight and blood pressure. We’re doing vaccines, we’re doing dental varnish. This is what we do. This is standard of care. This is not an operation that we need to give all of these explanations of what can go wrong. We know this is safe. I’m confident about that. I know the research.” There’s these normal things where, if we make them too open-ended, it makes you question, “Well, what is wrong with this? Why are we being so open-ended?”

Patsy Stinchfield: It instills doubt.

Dr. Bryan Fate: Exactly.

Patsy Stinchfield: And then, doubt begets fear, and then parents are like, “Am I supposed to decide? You’re the one who went to medical school.”

Dr. Bryan Fate: Right, yeah.

Patsy Stinchfield: And now, the decision-making is unclear. Those kind of questions really cause problems.

Dr. Bryan Fate: And of course, you do want to balance that with informed consent, shared decision-making, respect for autonomy.

Patsy Stinchfield: Education.

Dr. Bryan Fate: Education of course, because we’re partners. We want to know what the possible side effects are. We want a full picture, but also, we don’t need to get too in the weeds, because we know how safe and effective vaccines are.

Patsy Stinchfield: Exactly.

Dr. Bryan Fate: And then, I talked a little bit about being comfortable with silence. You have so much experience during the pandemic, and during outbreaks, Patsy. I just feel like as clinicians sometimes, we really want to fill every space. We’ve got three patients waiting, we don’t feel as willing to just sit and let there be silence, because it feels awkward, but I’ve found that the times when parents change their mind are often after those pauses that you have to just let be ,essentially.

Patsy Stinchfield: I do think silence is important. I think the biggest barrier to silence is just the design of our clinic schedules. We don’t have a lot of time, so time is always that monkey on everybody’s back, and the parents, too. “I’ve got to get home and pick up my other kid from school.” I think time is always that unspoken visitor in the room of, do we have even time to sit here in silence? Silence is very powerful, especially if you are looking at each other, if you’re close to each other. Basically, an unspoken word says, “I’m listening, I’m here.” One of my favorite phrases was, help me understand. Help me understand your thoughts about this, or etc. And then, just sit quietly and let them think for a little bit, and their silence and your silence merge together. That’s where you’re in this trusted conversation. You show you really are interested in what they’re thinking. It’s not like they’re coming in and they’re going to get a monologue from you as the provider.

Dr. Bryan Fate: That’s part of motivational interviewing, too, which is another part of this article. Open-ended questions are so important. Affirmations of, “I know you’re a great parent, I know you want what’s best for this kid, and we both do together.” Reflections, being like, “I hear you. Here’s what you’re telling me. I’m not trying to just launch into what I want to say. I’m giving you space and time, and eye contact and body language.” And then, permission to share sometimes, too. “Is it okay if I tell you more about why I think this is safe, and MMR does not cause autism?”

Patsy Stinchfield: Motivational interviewing, it’s really more of a psychological conversation, almost, in that you’re really trying to get at the root of their behaviors. What is motivating their fear? What is motivating their unwillingness to vaccinate? It takes time to have motivational interviewing conversations, so in this scenario, as the provider’s leaving and the kid is unvaccinated and the parent is unsure, I would say, “Let’s set up a time where we can have a 20-minute visit, and we will have more of a conversation.” That’s when you get into motivational interviewing. You do a follow-up visit, or you set up an every Thursday noon chat at Children’s, where you come in and parents can talk, and have a little bit more time to have some of those fears heard. Whoever shows up that day, that’s the conversation. I think you can build it into your clinic structure, such that the time that motivational interviewing requires is actually given.

Dr. Bryan Fate: The structure of clinics, sometimes it’d be nice to recalibrate our priorities, and make that a thing that happens.

Patsy Stinchfield: That’s right. You start with the presumptive, “You’re here for vaccines today. Your child needs this many vaccines, we’re going to do this, this, and this.” That presumes you are both on the same page of vaccinating. And then, you vaccinate or you answer a couple of questions. Or, if they’re like, “No, no, no,” that’s when you shift to, either if you have time at the moment, motivational interviewing, or you set up a time to talk further.

Dr. Bryan Fate: I think a really key point from this, too, that should bring pediatricians hope, is that in all of the research that’s been done, pediatricians are still the most trusted source of information about vaccines. They’re still the most sought after. Just like you said, Patsy, that connection, that trust, that continuity brings over time. Sometimes you’re planting seeds that hopefully blossom in future visits, too.

Patsy Stinchfield: Right, and they want you to be strong. They want you to say unequivocally, “Vaccines are the most amazing and marvelous medical intervention in the last decades, and they’re effective. They will protect your child. I have given them to my children. I want nothing less for your children.” They want you to be strong, and it’s okay to be a recommendation that is crystal clear. That’s exactly what should happen.

Dr. Bryan Fate: Beyond this article’s recommendations, Patsy, you have decades of experience in the field during the heat of outbreaks. You’re also an adept storyteller, weaving empathy and emotional impact with evidence. What has worked best for you in instilling vaccine confidence during conversations that we haven’t covered so far?

Patsy Stinchfield: My storytelling comes from my Irishness, I’ll just say that. I think the first thing we have to do is listen. Listen first, because there are multiple avenues to becoming vaccine hesitant. If we assume we know why they’re hesitating on that vaccine, we may assume wrong. We may be talking about something that they didn’t even have on their mind. Listen first, see where their concerns are, find out what is making them feel worried, and then, use a story. Use a story from your own experience as a parent, as a clinician. Use a story of another parent’s voice. When children got admitted to the hospital with vaccine preventable diseases, I almost always got called to come up and talk to the parent, who now is like, “Oh my gosh, I didn’t know haemophilus influenza B could almost kill my child. If I had known that, I would never have said, ‘let’s skip this one.'”

I share that, because parent to parent is a strong voice, too. They say to me, “Please tell parents, don’t skip vaccines. I wish I knew then what I know now.” This is from the intensive care unit of a children’s hospital, with a child on life support, many, many of those conversations. I’ll share some of those parent voices. The other thing I like to do, I talk with my hands quite a bit, and I’ll say, “Your interest is safety, and my interest is safety,” with my right and left hand. And then I put my thumbs together, and I say, “This is where we agree. You and I both want what’s safest for your child.” And then I can ask, “How do you think not vaccinated would be safer for your child than vaccine? Let’s talk about that. Help me understand that.” If you can start from a place where you both agree, that’s better than starting in two opposite corners.

I think also, just the storytelling is really, really important from your own experience, but starting early. Even OB-GYN visits, I have this dream of, we have lactation specialists in OB-GYN, and I really want to have a vaccination specialist whose whole job is to talk to parents who are about to become parents, and especially the first time, welcome to the club, there’s a lot you need to know. They have not listened or paid attention to vaccine information before now, but now, it’s like, “I can’t eat cheese, and I shouldn’t do this. What about vaccines? Should I get vaccinated? Is it going to hurt my baby?” They’re thinking about this. When they’re thinking about it, that is your time to start to educate. By the time the baby’s born, you’ve lost nine months of good, healthy, evidence-based information, and they may have fallen in a rabbit hole of disinformation and misinformation. Those are some other things I do.

Dr. Bryan Fate: For our next case, a family brings in their healthy three-year-old for a wellness check. Mom is pursuing an alternative vaccine schedule abstracted from a parenting blog, and during motivational interviewing pulls up a long list of concerns on her phone. Instilling confidence, it’s important that pediatricians have ready and accurate answers to the many misconceptions about vaccines floating around. Patsy, first I just wanted to ask how the world has changed since you started practicing.

Patsy Stinchfield: From 1987, as a pediatric resident, as a nurse practitioner, no internet, no iPhones. Parents would come in, we’d say, “These are the shots you’re getting today.”

“Okay.” We gave them the shots and they left. We didn’t even have the vaccine information sheets. We just chatted about it. We just didn’t have that kind of pushback. Then, fast-forward, 90s, you’ve got the internet, WWWW, world-wide web, which I think is more wild, wild west to this day, and dot matrix downloaded questions of articles that you’ve never seen. “I’ll read it, and then we can talk later.” Now today, with you guys, iPhones and just all of this disinformation, misinformation, how do you know what is a reliable resource versus a Russian bot? It’s just so hard. I do think that we can do more to try to improve some of that social media business, but directing them via their phone to reliable resources while you’re sitting there, “Hey, let me show you, here’s where children’s vaccine information is. Here’s Children’s Hospital of Philadelphia, a great page for vaccine information. Here’s National Foundation for Infectious disease. Here’s Vaccinate your Family, Voices for Vaccines.” Right there, try to get them to look at those things, and then, that will come more into their phone. I feel for you.

Dr. Bryan Fate: And ideally prenatally, when they are information seeking.

Patsy Stinchfield: Exactly.

Dr. Bryan Fate: To piggyback on the last discussion.

Patsy Stinchfield: Exactly.

Dr. Bryan Fate: We’re going to do some quick speed round of some of the responses that you would give to some of the concerns about vaccines that we hear in our clinic, Patsy. Are you ready?

Patsy Stinchfield: I’m ready.

Dr. Bryan Fate: Number one, giving multiple vaccines is too much for a child’s body.

Patsy Stinchfield: The first thing you can do in that prenatal and first visit is, describe the power of the human immune system. Your baby can’t talk, can’t walk, can’t feed themselves, can’t roll over, but they are fighting mightily. All the fungi, all the things in the environment, germs, vaccines, food, they are powerful, and their immune system is waiting and ready to take care of these antigen. I love Paul Offit’s analogy of the ocean. Think of the ocean as massive, billions amounts of antibodies, and you’re giving an MMR vaccine that’s three antigens, that’s three spits in the ocean, and it knows right where to go.

Dr. Bryan Fate: Number two, my child is unvaccinated and has been healthy their whole life. Why would I give a vaccine?

Patsy Stinchfield: They’re lucky. I can just be short and sweet. They’ve been lucky. This is a risk you do not want to take, because the younger they are, the more vulnerable they are, and to not vaccinate is to take a risk, a significant risk. The fact that they’ve gotten this far, it is that they’re lucky, but luck does run out.

Dr. Bryan Fate: Number three, I’d like to do only natural things for my child, like turmeric and elderberry.

Patsy Stinchfield: These things come up often. I researched them all. There is not evidence that those things are better than your immune system. It’s typically, they might work, but you’d have to have them in massive doses for them to make a difference. There really is nothing more natural than the way that your immune system works. Think of this. Vaccines are so incredibly amazing that you give a little bit of the antigen, that gives you a little bit of the “Mini disease,” and then, lots of antibodies. If you ever encounter that real disease, you’re protected. It’s about as natural as you can get.

Dr. Bryan Fate: Number four, I’d like to pursue my own schedule because of things I’ve read online.

Patsy Stinchfield: Well, your own schedule has not been studied or approved by anybody of scientific authority. There are hazards in spreading out vaccines. You have to get in the car and drive, and driving, potential car accidents, you’re actually increasing your family’s risk. There’s been some really good nursing research on pain at vaccines, and measuring babies crying, how long they cry, et cetera. Your baby doesn’t have any more pain with four vaccines compared to one vaccine. The best thing to do, as my mom used to say, we’re just going to get her done.

Dr. Bryan Fate: Number five, vaccines cause autism.

Patsy Stinchfield: I’ll just say, “Gah.” No, seriously, that’s the bubble over my head, every time a parent asks me that, but that never comes out of my mouth. You can never sound judgmental or roll your eyes, or get exasperated, even though that is exactly how we all feel. Keep it in the bubble over your head. What comes out of my mouth is, that is a common concern, and there’ve been more than a dozen very large international studies that has looked at this question and has not been found. The person who brought this theory forward has lost his medical license for fraudulent studies and nefarious reasons for bringing that forward. MMR vaccine, any vaccine has nothing to do with autism.

Dr. Bryan Fate: The influenza vaccine gave my child the flu.

Patsy Stinchfield: Common, common thought, and what I say is, expect some feelings after your flu vaccine of feeling yucky. We need to tell parents to expect this, of maybe even some low grade fever, maybe some body aches, maybe just being sleepier than usual. You should expect that. That’s not the flu vaccine virus itself. It’s your body’s immune system going, “Wait, wait, wait, what’s going on here? I’ve got to work on this.” All those massive immune cells are recognizing that flu, taking it in and being ready for, if you get the real deal influenza, you will never forget it. You get hit by a truck, every bone in your body hurts, headache, high, high fever, bad cough. You will know when you have influenza. Those symptoms you’re describing is not the flu.

Dr. Bryan Fate: And then, the last one, I don’t want my child to get any of the newer vaccines, as we don’t know that they’re safe.

Patsy Stinchfield: I’ve had the inside seat on this, and being a voting member and liaison member to the advisory committee on immunization practices at CDC, and I can tell you it is decades before vaccines come to our awareness, and the rigor and work that goes into making sure that vaccines are safe, they are not just put out by a manufacturer and skipped over. There is so much rigor and safety, it makes me feel very confident in our American vaccine system. All these meetings are online, it’s transparent conversations. And then, following approval, we have vaccine adverse event reporting system, the Vaccine Safety Data link, and CISA, the regional places that we can have people go if they have a vaccine concern. And then, the manufacturers are studying those vaccines afterwards. I think newer vaccines should not be a point of concern for parents.

Dr. Bryan Fate: In our next case, as public health disciples, we know that 90% and much more of health determinants live outside of clinic walls. As rates of MMR vaccinations decline, we seem on the cusp of another measles outbreak in the Twin Cities, which disproportionately impacted the Somali community in 2017. Indeed, some of the strongest held reservations about MMR come from our clinic Somali families, wonderful, doting parents who only want what’s best for their child but are terrified by the prospect of autism. Patsy, I was hoping, in your work with the 2017 outbreak, if you could give us just a little bit more history behind some of these MMR and autism fears in the Somali community.

Patsy Stinchfield: That outbreak really was based on the myth that MMR causes autism. It was bought into by the Somali community, their leaders. After their leaders, many of the imams were visited by Dr. Andrew Wakefield himself, twice came to Minneapolis and spoke with them and said, “You should fear MMR, you should not give it.” They turned around in their mosques and told people that, so over about a decade, we saw the vaccine rates drop from the highest of any population in Hennepin County two year olds, at 92%, down to 42%. Anything under 90% is an outbreak waiting to happen. Yeah, think of that. There were big gaps in understanding, big gaps in trust. Some of the moms who did not vaccinate their children and they ended up getting measles, I went in every one of those rooms and talked to all those parents, and one mom said, “I didn’t know that the M in MMR was from measles. My cousin died of measles in Somalia. If I had known MMR, the triple shot, I was told, ‘Don’t get the triple shot,’ if I’d known that was measles, I wouldn’t have skipped it.” So.

Fundamental information, that was missing. We have to remember, we just roll off MMR, but we need to say it, measles, mumps, rubella. What are we talking about? We also really needed to listen a lot more than we did. They felt heard by an anti-vaccine leader and not heard by us. He went out to them. We did not go out to them. Eventually, as the outbreak was going on, we took the same tact, and went out and met with imams, a panel of us, and broke it up into three groups. We talked about the seriousness of measles, we talked about the safety of MMR vaccine, and we talked about autism, how there’s nothing to do with each other, with MMR and autism, and that helped, I think. We had three experts in each of those areas talk to these panels of leaders. Then they turned around and went back, and talked to their community. And then, we did start to see rates improve.

We’re not where we need to be still, but I think the best thing I did first, when we set up our incident command, was to gather our trusted Somali employees at Children’s, I can name a lot of them, that we went hand in hand and just said, “Tell us what we should do. I don’t want to make any cultural mistakes. I’m going to follow you. You lead, I’ll follow.” We just worked and partnered all the way to a live BBC interview. I, as an Irish girl, shouldn’t be answering, what did the Somali families think about MMR vaccine? How about we have a Somali employee answer that question? That’s what we did.

Dr. Bryan Fate: I think one thing that I see is, there are pretty robust responses that take place when an outbreak happens, and once the outbreak is contained, everything fades away.

Patsy Stinchfield: Right.

Dr. Bryan Fate: Some of the situations go back to what they were, the coals get hot again, and suddenly, we’re responding to another emergency, as opposed to something that’s sustained, and kept alive without there needing to be that precipitating factor. Just wondering what your thoughts were in terms of how we can continue these partnerships, keep those relationships with trusted leaders, how we can make that work sustainable and lasting?

Patsy Stinchfield: Well, your observation is correct. I think we are very reactionary to these things, and I think partnerships with public health and primary care providers, hospitals like Children’s and others, are really critical ongoing, not just in the dark times. I think we have to remember that misinformation and disinformation about vaccines is all around us, and it has to be fought every day. Cultural nuances really have to be understood from within. We cannot assume that we know what a specific community thinks and needs and wants. We have to listen. And then, I think also, that trust-building takes time, so start working on that now. Go to Iftar dinners. Do you have Somali friends? I do. Do you have a community relationship that you feel comfortable in? I think it’s really fundamental that information can be missed or misunderstood, and we have to make sure that people can access that in a culturally appropriate way.

Does your clinic look like the patients they’re serving? Are you able to speak multiple languages? Are you able to serve people in a sensitive way? I think we also need to work with legislative, work with the American Academy of Pediatrics. I worked with our NNP, our National Nurse Practitioner, on regulatory issues like the California Senate bill. That really is, no more religious reasons to opt out. Make it structurally difficult to not vaccinate your child. I really do encourage people, any pediatrician, nurse practitioner who has not attended the National Foundation for Infectious Disease Clinical Vaccinology course, it is inspiring to you to keep doing this important work. You will leave like, “Yep, I have new tools, I have new tricks, and we all have to keep doing it,” and making vaccination the social norm. It is. I say this often, the majority of American parents vaccinate their children on schedule, and that’s what we want for your child.

Dr. Bryan Fate: To conclude, Patsy, I just wanted to have you list a couple of take home points for listeners based on what we’ve been discussing today.

Patsy Stinchfield: Well, my first point is, listen first. That’ll get you on the right road. Second point is, difficult conversations are best in trusted relationships, so build trust, and know that every little conversation you’re having is doing just that, is building trust. Third, don’t give up. Remember, we work for the child. There’s three people in that room who have opinions. That baby can’t express their opinion, but we work for that baby who wouldn’t want to choose suffering. They wouldn’t want to choose disease. Making sure that we don’t ever give up, even as tiring as it is for a clinician, don’t give up, and make every visit a vaccine visit.

Dr. Bryan Fate: Every visit a vaccine visit. Thank you so much, Patsy, for joining us. It’s been such a pleasure. Until it’s time to crack another case, a musical number to engage the emotive side of your brain, and hopefully, tug at your heartstrings.

Music:
Ready to sing? Shots keep me safe.
Shots keep me safe.
Shots keep me strong.
Shots keep me strong.
One little pinch, and it’s all done.
Yes, I am brave.
Yes, I am brave.
Yes, I am kind.
Yes, I am kind,
You get yours, and I’ll get mine.
Shots keep me safe.
Shots keep me safe.
Shots keep you strong.
Shots keep you strong.
We protect the old and young.

Dr. Kade Goepferd: Thank you for listening to Talking Pediatrics. Come back next time for a new episode with our caregivers and experts in pediatric health. Our showrunner is Cora Nelson. Episodes are produced, engineered and edited by Jake Beaver and Patrick Bixler. Our marketing representatives are Amie Juba and Krithika Devanathan. For information and additional episodes, check us out on your favorite podcast platform or go to childrensmn.org/talkingpediatrics.