‘Taking Paternalism Out of the Conversation’ to Enable Better Health Discussions


The American College of Physicians (ACP) CEO says it is important for physicians to move away from this traditional approach to transition to an empathetic style of discussion with patients so they can better relate and help those in need get back on track with their health post-COVID and schedule routine tests and immunizations.

ACP CEO Darilyn V. Moyer, MD, MACP, FRCP, FIDSA, FAMWA, FEFIM, reminds people that many internal medicine clinicians were working as critical care physicians in hospital ICUs treating the most severe COVID-19 patients during the height of the pandemic and the weight of that responsibility alone was tremendous and has had a huge, lingering effect on clinicians. She points to some people retiring early or leaving the field altogether as examples.

“A big concern that we are seeing, not just for physician organizations, is unfortunately the burnout and brownout on the front lines for our already stressed healthcare system,” Moyer states.

Despite these challenges, physicians must continue to move forward, and in trying to combat these issues, Moyer’s organization, ACP, has developed resources including videos to help clinicians cope with the stress.

“We created a series of videos, in conjunction with our wellbeing professional fulfillment group, to talk about how to manage through this," Moyer said. "These are three to five minute videos that were created by experts in the field to talk to people about what happens when you get frustrated or you get angry, and how to regroup and reapproach how you are thinking about this.”

ACP is the largest medical specialty organization in the United States, and has members in more than 145 countries. ACP membership includes 160,000 internal medicine physicians, related subspecialists, and medical students.

The pandemic’s effects linger not only for physicians but for patients as they try to get back on track with their health check-ups, tests, and vaccinations. This latter concern has been one that has greatly affected the pediatric population.

Although the overall childhood immunization rate remains high in the United States, there has been a decrease in vaccination rates of school-aged children—and it takes just one child who is not up-to-date on their shots to create an outbreak. 

Earlier this year, the CDC reported that in the last 2 school years, the national coverage for childhood state-required vaccines among kindergarten students declined from 95% to approximately 93%. And while this does not sound like a large number, it still represents thousands of young children not getting their vaccinations such as the measles, mumps, and rubella (MMR) vaccine. It is also a disturbing trend as some people may feel they do not need them or are fearful of vaccines.

Communication remains a top priority between clinicians and patients, and Moyer believes transitioning away from the traditional paternalistic relationship between the 2 parties to a partnership is important to not only convey information but listen to patients’ needs and why they make decisions about their health.

“We have a whole new generation of folks [who] get their information differently,” Moyer said. “They expect professional relationships to be two way streets…I think the other thing is to remember that folks didn't go to medical school and do six or seven years of training, and making sure that you're meeting them where they are, and that the information and what you're discussing, is really understandable.”

Moyer is board certified in internal medicine and infectious diseases, and understands the importance of updating the membership with the latest clinical care information. She says ACP has been doing more in terms of publishing COVID-19 articles in its flagship publication, Annals of Internal Medicine, and providing web forums with guest speakers. They have been working with leaders in the field including Carlos Del Rio, MD, interim dean, Emory University School of Medicine and interim chief, Academic Office for Emory Healthcare, who has been a frequent speaker.

In a wide-ranging interview with Contagion, Moyer speaks about the lingering effects of COVID-19 on public health, changing communication styles to adapt to today’s patients, the significance of routine immunizations, and the shortage of new infectious disease clnicians going into the specialty today.

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