COMPULSORY FLU SHOT FOR HEALTHCARE PROFESSIONALS?

August 21, 2014


A perennially controversial topic that continually divides the medical community is the discussion on mandatory flu vaccination for healthcare providers, and there’s no international consensus right now.

In Canada, less than 50 per cent of healthcare workers get the flu shot. Conversely, at U.S. medical centres like Virginia Mason in Seattle, Washington where it’s required, vaccination rates are 98 per cent. There’s no national standard in Europe, and even in countries with mandatory policies these aren’t always implemented.

Dr. Michael Gardam, director of infection prevention and control at Toronto’s University Health Network, gets the shot. However, in a 2013 commentary published in the Canadian Medical Association Journal (CMAJ), he argues that it may be premature to make it compulsory for healthcare providers because the vaccine is imperfect.

The shot is only about 60 per cent effective when it matches the season’s circulating strain, because although every seasonal influenza vaccine includes three different strains, at least one of these guesses is wrong up to 20 per cent of the time.

Does this mean we’ve actually overestimated how well the flu vaccine really works?
Dr. Allison McGeer, director of infection control at Mount Sinai Hospital in Toronto and a leading flu expert, doesn’t think so, arguing that those hesitant to enforce mandatory vaccination should consider the shot’s purpose.

Prevention isn’t foolproof, but since the vaccine protects healthcare workers and saves patients’ lives, McGeer believes that making it compulsory should be considered.


British Columbia is the first Canadian province to make the flu shot mandatory for all healthcare providers. This policy, which came into effect in 2012, means that healthcare workers who don’t get the vaccine have to wear a mask while they’re in contact with patients during the flu season.

However, Debra McPherson, president of the B.C. Nurses Association, argues that forcing healthcare professionals violates their civil rights, because they should have sovereignty over their bodies and the right to choose whether getting vaccinated is the right thing to do.

An editorial in the October 2012 CMAJ called for obligatory vaccination within the health care community because patients’ lives depend on it. If workers feel they’re losing their choice, they need to consider the best interests of their patients, wrote Dr. Ken Flegel, the editor.

In a global atmosphere of increasing reluctance around vaccines in general, it’s crucial the medical establishment provides accurate information about the benefits of individual vaccines. It is only with an evidence-based dialogue that we can truly protect public health.

HEALTH LITERATE OR ILLITERATE

August 14, 2014

Every time I see or hear the words “health literacy” I cringe, and I am an Adjunct Asst. Professor of Medicine in Health Evidence and Policy at Mount Sinai School of Medicine. I realize it does describe a field of study, and that there are smart linguists who I respect who have devoted their lives to evaluating health literacy. But, the bottom line is that I still think it’s a bad term, or at least one that should be used sparingly.

To me “health literate or illiterate,” sums up what I often think is wrong about how the medical profession deals with patients, families, and the public. Doctors and scientists describe patients as non-compliant, or not literate i.e. the problem is the patient. The problem could never be the doctor or the healthcare system. Instead patients aren’t smart enough or they don’t behave well. Patients just don’t do what they need to do to get better or stay well.

Well, here’s a news flash, we in healthcare are a big part of the problem. We need to do better. We need to convey information more clearly—in ways patients and their families can digest. We need to tell stories that allow patients to not only understand, but also feel the value of adhering to a medication or changing their behavior.

Navigating through healthcare challenges and changing behavior is hard. We shouldn’t view ourselves as smart, and patients as some degree of literate, but rather try to understand illness and wellness as a shared opportunity. We should be using the best tools, the best story telling, and the most concise and relevant information to partner with patients for their health, and the health of our profession.

UNDERSTANDING HEALTH

August 11, 2014
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Understanding critical health and safety issues remains a national crisis. At least 50% of US adults have difficulty understanding and using health and safety information. That is 50% of ALL Americans. If you look at the disadvantaged that figure becomes an eye popping 80%. In fact, a Department of Education survey commissioned in 2003, found that only 12% of English speaking adults demonstrated proficient health literacy.

And that figure has remained static for a decade… in spite of all of our cool, new technology, in spite of round the clock cable news and social media, in spite of mobile search, public understanding of important health information is at failing levels.

There is 25 years of evidence that low health literacy is linked to poor health outcomes. It has been linked to preventable hospital visits and re-admissions. And it hits the vulnerable particularly hard: older Americans, Blacks and Hispanics, recent immigrants and, of course, the poor. All groups that particularly need to understand their healthcare situation.

And all of us are paying for this problem. One study cited in an Institute of Medicine report on the problem: Health Literacy: A Prescription to End Confusion estimates that the cost of limited health literacy is between $106 and $236 billion dollars.

With all the money we are devoting to healthcare in America, isn’t it time we tackled better public understanding of health and wellness?

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