Where’s COVID-19 vaccine hesitancy coming from? How do disparities in underserved and marginalized communities affect health equity and outcomes? On the debut episode, hosts Kari Haley, MD, and Steven Jackson, MD, welcome guest Zeke McKinney, MD, for an eye-opening discussion on health care access and community education.
Where’s COVID-19 vaccine hesitancy coming from? How do disparities in underserved and marginalized communities affect health equity and outcomes? On the debut episode, hosts Kari Haley, MD, and Steven Jackson, MD, welcome guest Zeke McKinney, MD, for an eye-opening discussion on health care access and community education.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Zeke McKinney, MD
Dr. McKinney on Twitter: @ZekeMD
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome to the show. In this episode, we spoke with Dr. Zeke McKinney. He's a HealthPartners environmental medicine and occupational physician. He also serves as a clinical investigator at the HealthPartners Institute.
Kari Haley:
We had a wonderful conversation about equity and education within the community.
Steven Jackson:
In this health equity space. We tend to talk a lot about building trust and the importance of building trust, but it's not without its challenges, from having to see a lot of patients and the pressure that comes with that versus needing to take that extra time to develop a relationship so that it can be beneficial, both medically and professionally, makes it tough.
Zeke McKinney:
Developing that trust and just doing the basic communication with the person right up front, and I feel like so much in our world of volume based care, fee for service care.
Kari Haley:
Yes.
Steven Jackson:
Right.
Zeke McKinney:
We're rushed to see people faster and faster and faster.
Steven Jackson:
Great point.
Zeke McKinney:
And unfortunately, that's the stuff that gets lost because oops, I just got to look in your ear and diagnose your ear infection and give you antibiotics and get you on your way.
Kari Haley:
I think Dr. Zeke McKinney really was able to give us a great understanding of the difficulties that it can be to really balance things between the demands that are placed on us as health care professionals, all the metrics that we need to meet, all the satisfaction metrics we need to do, but then also, having that true relationship with the patient that gives us the ability to build that trust.
Steven Jackson:
And just like relationships aren't one-offs, there's a continual process of cultivating that relationship, and building it. Same thing with trust. You have to continue to build trust through every interaction, through follow up, through any other thing. You always build trust or hurt trust, and that's one of the points, I think.
Zeke McKinney:
We can't be judgmental about our patients. I think sometimes, if a patient comes in with that stack of stuff they printed off the internet, we're immediately like, our guard goes up and says, "No, no, no, no, no." It's not like that. Like with everything, you have to take patients concern seriously, and to be honest, I'd say at least half the time, people come in with information that might be relevant. The problem is, you put in your myriad of random symptoms and you can get anything from cancer to pneumonia, to you have a simple cold. That's where it can be dicey, but again, I think at least taking people seriously and looking at what they bring you. Maybe don't try to use your whole visit for that, or if you have to then, make sure you get another visit with them, but taking their concerns seriously and figuring out, what is it about what they're doing that's good. Thank them for being engaged enough to try to even figure out some of it for themselves, even though they're may good and bad sources.
Zeke McKinney:
I think we could all do better in maybe having a handout ready for patients and saying, "Hey, here's some reliable sources of information on the internet." Of course, you're never going to be able to make really complex diagnoses, but at least maybe it'll help you understand whether or not you should be concerned. The question I get from people out on the street all the time is, "Well, should I go to the doctor for X?" And I've already broken it down to a really simple algorithm. Number one is, do you feel like you need to go to the doctor? Because if the answer is yes, then just go.
Steven Jackson:
Just go.
Zeke McKinney:
But number two is, do you have a fever? Can you eat? Can you drink? Are you throwing up? Are you having trouble going to the bathroom? Are you bleeding profusely? If the answer to all that's, no, then maybe not.
Steven Jackson:
One thing that Dr. McKinney highlighted was sometimes the intimidation that we get as clinicians when patients come in with a list of symptoms from Dr. Google. I know I have, and try not to.
Kari Haley:
It can be really difficult when people come in, especially with their preset expectations and trying to find a way to have that conversation where maybe everyone's expectations can try to meet in the middle, but I think Dr. McKinney really highlights that need to really make it a conversation, make it a partnership, and involve our patients and think our patients for being part of the health care.
Steven Jackson:
Yeah. I think he's really opening up a door for us to really look at our patients as advocates for themselves, not annoyances with a long list of things that we have to now source through. Let's face it, they're probably scared, have a lot of questions and they've taken that initiative to try to find out about their care, so I think that's a good thing, and I think that something worth acknowledging. Trust came up in a different way later in our conversation with Zeke in talking about really explaining to patients what we're doing and why we're doing it. I've often talked to patients who let me know pretty early on where their trust is when they say things like, "What are you about to do to me?" And I find it interesting that really having that conversation about, this is what we are doing and utilizing basic communication, it goes a long way.
Kari Haley:
I agree. I think one of the big things that I've learned when wrapping up visits and about that trust aspect of things and that communication, is instead of saying, "Do you have any questions?" Where it's a yes, no answer, and people maybe feel obliged to say, "No," opening it up and saying, "What questions do you have for me?" at the end of the encounter, so they can feel free to say whatever is on their mind to really help foster a relationship in a fast-paced setting.
Steven Jackson:
That's a great point. Let's take a listen.
Zeke McKinney:
Every person, let's say in the U.S., has probably seen a movie where some doctor's examining a guy and they're somewhere near the groin, and he says, "Turn your head and cough." You guys are looking at me like you know what I'm talking about. And so then, people assume that the doctor's doing some sort of testicular exam, and I know you guys know what it is, but maybe our audience doesn't. So, I see men for pre-employment exams or being certified for being a commercial motor vehicle driver, and for those people an incarcerated hernia could be a very, really bad thing. Before I do that type of exam on a man, I say, "Well, first of all, do you know what a hernia is?" Maybe half the time, guys say, "Yeah, I do." and that's cool, and maybe I don't need to go onto all of it. But some people say, "No, I have no idea." And I say, "Have you ever had this kind of exam done?" "No."
Zeke McKinney:
And so, I go through this whole thing, explaining to him, I say, "Look, I'm not checking your testicles. I'm not checking anything in your groin. I'm trying to check for a hernia, which is when there's a problem with the lining of your abdominal wall and then your intestines can push through, and if they get caught on that hole, then it kind of hurts a bit, and if they get really caught, it can cut off blood flow, which is life-threatening, and so that's why it's concerning. I felt like I had to tell you this, because I'm not going to ask you to remove your pants in the exam room before telling you why I'm doing that." It's even simple things like that, and hernias are one of the most common things that are seen in medicine, in general surgery, but your average person has no idea what that's about.
Zeke McKinney:
I guess the point I'm making is I would argue more for advocacy to get health education out to the community, whether it's in schools or whether it's, I don't know, a second annual exam where you meet with your doctor and they say, "Well, hey, just tell me what you know about yourself." I don't know. That's crazy, but I think there's a baseline level of knowledge that we are not even meeting and it gets worse because people of the doctor and they don't know what to expect. So, sometimes we're frustrated because patients aren't telling us what we want to hear, but how would they know what we're asking about?
Steven Jackson:
Coming from a family that tends to only go to the doctor when it hurts so bad that they can't move, it's important, I think, to really begin considering what are our expectations when going to the doctor and Zeke really did a good job of talking about that.
Zeke McKinney:
It's really basic things like that, that we've never even taught people like what to expect when you go to the doctor. Here's why the doctor's going to do these things. Here's why they're going to ask you these questions. You don't need to be scared about that. You don't need to be offended about that. They're not trying to be all up in your business. If you tell your doctor, you smoke pot, are they going to turn you into the cops? No. You guys know no, but people are scared to talk about that kind of stuff, and maybe sometimes it matters. I don't know. I guess to answer your question, I have personal strategies for trying to educate people in real time, but I think we need to do much better at a public health level, at a community level to really educate people from a young, young age. Patients should know what their liver is and what their pancreas, at a base level, what all the parts of their body do and why that matters.
Kari Haley:
This was a conversation I really appreciated because if you think about it, you can go on YouTube and you can learn how to do absolutely everything and anything, and learn the exact steps of what's going to happen, but we don't have that same sort of education or opportunity for our patients who are nearly everyone, to have that same expectation, knowing what's going to happen to them, what questions are going to be asked, and the whys behind it, which I think is really, really important for building trust.
Steven Jackson:
How much easier would be if patients came in with a sign on their forehead that said, "This is what's wrong and this is what I need."? Too bad that's not a reality.
Zeke McKinney:
I wish people would come in being prepared to say, "OK, here's what I want from you today." Not me saying, "Here's what I'm prepared to give you today." That's, I think, the wrong approach.
Kari Haley:
In medical school, we are trained on a chief complaint basis, which is basically just, why are you here? Oh, your chief complaint is... What is the primary reason for your visit today? It would be really great if people could walk in and be able to verbalize that to us as their provider.
Steven Jackson:
I really like Zeke's no nonsense approach to getting the vaccine. You either get it or you don't. Get the consequences of getting it or the consequences of not getting it, and it was pretty straightforward.
Kari Haley:
I think it does really address as well, a lot of people's hesitancy still out there saying, "We don't know enough about the vaccine," or "I don't want to get the side effects of the vaccine," but it's really truly that, as a choice. It's either knowing the risks and benefits of the vaccine or the risks and benefits of getting COVID.
Steven Jackson:
Let's take a listen.
Zeke McKinney:
To me, and maybe I'm oversimplifying it, but I look at it really as, we only got two choices. Option A is you get the disease and you deal with the consequence of that, whether it's short term or long term, or you get the vaccine and you deal with the consequences of that, whether it's short term or long term. To me looking at that perspective, the benefits greatly outweigh the risk of getting the vaccine. We know there's long term COVID syndrome in some people and that's a roll of the dice, was you're going to be one of those, and you know what? I wouldn't want to face that. In general, long term effects from vaccines are exceedingly rare or on the border of, never happen. If those are my choices, look, we want to get done with this. People want to go out to the bar, they want to go out to the restaurant, they want to hang out with their friends, they want to go to weddings, they want to go to funerals. If we want to get past this, then we all have a responsibility to get immunized because otherwise we're never going to get there.
Steven Jackson:
I want to put it out there real quick that first of all, COVID-19 is not a racist condition or a racist disease in it of itself, but Dr. McKinney talked really specifically about how systemic racism plays a role in the rate of disease and how it disproportionately affects certain populations.
Zeke McKinney:
When the pandemic first started and we were seeing disparate rates of disease, death, hospitalization, and communities of color, people said, "Well, gee, is it something biological? Is it something different about being Black that's making me sick."
Kari Haley:
I remember this.
Zeke McKinney:
Yeah, this was real. What we had to explain to everybody was, "No, it's absolutely not biological." In fact, it is all about systemic racism. It's about all these social determinants of health that play a role in people's health, whether it's access to health care, access to health insurance, access to transportation, education, financial support, the built environment you live in, all of these things. Those are what drive the rates of chronic disease we see that are greater in communities of color and consequently, the rates of COVID severity and death that we saw in communities of color. The more that we, as clinicians or clinical systems or even insurance companies, can address those social determinants of health, the better off our patients are going to do. If you want to fix the system, here's Zeke McKinney getting on his real soapbox and probably somebody's not happy about me saying this, but insurers, they should spend all their money on that stuff because as you guys know from being in clinic, I'm just making up a number here, 75% to 90% of what we deal with are related to those social issues more than my ability to hand somebody a blood pressure medication.
Steven Jackson:
Yes. Yep. I think in a data driven world and rightfully so, we make a lot of medical decisions based on numbers say and what the measurables say, but one thing that was highlighted was just the importance of the story behind the numbers, and sometimes the story gives more information than the numbers ever will.
Zeke McKinney:
Some of the strategies, and I think we note some of this in medicine is, people are often much more affected by anecdotal evidence, stories about your friend's family, things you've observed, more than just saying, "Well, these are 70%, 80%." I'm not expecting the public to be epidemiologists and you don't want to do that. You never want to come off as someone who's living in an ivory tower and doesn't understand the experience of people on the ground.
Kari Haley:
I really like what Zeke said, because it makes me just think about bringing it home, as kind of a theme of bring it back to your house. How would you talk to your mom or your sister or your best friend about what's going on and talk to our patients like that and give them the stories and the anecdote, because really that brings that humanistic touch to medicine, which we all learn and strive for.
Zeke McKinney:
That's probably the best strategy you can have, being genuine, being yourself. I'm not just scientist, Dr. Zeke McKinney, I'm just a guy, Zeke, who lives life and some things I'm scared about too, just like everybody else.
Steven Jackson:
Speaking of being yourself, Zeke shared a story that really highlighted need to take the message to the people for those that are vaccine hesitant and for those that just have a lot of questions. He answered the question, "How can we get the message out there?"
Zeke McKinney:
This happened back in the summer, and this was actually my first time going to this barber shop, but part of it was, I was really trying to figure out how to get plugged in to the community. I said, "I'm going to go get me a barber over north where I grew up and maybe somebody can do my hair better anyway." No, I'm just kidding. So, I go in there and then I got a mask on, and there's maybe, I don't know, 10 or 15 people, maybe not that many, maybe 10 or 12 people in there, and nobody's wearing a mask and people are definitely not distanced. I'm looking around thinking, are people worried about this or not? I was a little bit hesitant to even bring it up because I wasn't trying to upset people. I'd never been there before, but I finally did and said, "Look, I don't know if you guys know, but we're in the middle of a global pandemic. This is a real thing. I think there are actually even laws requiring you in this environment to wear a mask and only have so many people in here."
Zeke McKinney:
And the owner of the shop, I think he took that seriously and he wasn't resistant to me saying it. The guy who was cutting my hair was kind of like, "Aw," and he was showing me some stuff online, some more conspiracy theory-ish type stuff, but in any case, at least people were open to having a dialogue, and that was fine. I wasn't disparaging of people's views and they weren't mad at me for bringing it up, so that was good. Now, here's the follow up to that story? So when I went back to the barber more recently, because I had kind of delayed during the fall, especially when things spiked around November and I just had to cut my own hair and it looked funky, but this is more pro level now.
Steven Jackson:
Thank you, Zeke. Thanks for sparing us. Go ahead.
Zeke McKinney:
As soon as I go in, the barber says, "Hey man, where can I get a vaccine?" I said, "Oh really?" He said, "Well, I wasn't sure if I wanted to get one before, but now I do think I do want to get one."
Steven Jackson:
Wow.
Zeke McKinney:
I said, "Oh, yay." Now, did I have any impact there? I don't know, but at least, this was my point. I, for a second, going in that first time was like, you know what, maybe I just need to turn around and get out of here. I wasn't vaccinated. Vaccines didn't even exist then, and I decided, you know what? I got to brave it out because how can we be on the ground and engage people if we're too scared to be in those environments that may not fit within our comfort zone.
Steven Jackson:
What a conversation. Just really appreciative of Zeke taking the time to educate us and to inspire us to really go after the change that I think would benefit all of us.
Kari Haley:
I enjoyed his really just bringing it to being normal humans and interacting with our patients the way we would interact with others in our community and showing our leadership within our communities, by being an advocate for people's health. If you want to hear more from Dr. McKinney, you can follow him on Twitter @ZekeMD.
Steven Jackson:
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers, and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.