A Family Physician Says The Pandemic Has Changed The Doctor-Patient Relationship
Misinformation about COVID-19 and vaccines is abundant. Many people believe what they hear on television or see online over the word of experts, even a family doctor they with whom have an established relationship.
Dr. Greg Cohen is a family physician in Lucas County, Iowa. While his patients trust his work checking for diabetes and other ailments, that trust stops for many as he asks them to get vaccinated or wear a facemask to prevent the spread of COVID-19. He's written about his frustration and an op-ed published on the website Bleeding Heartland, and he spoke with Charity Nebbe about his frustrations on Talk of Iowa.
This conversation has been edited for length and clarity.
Nebbe: “We've talked on this program many times about how the early months of the pandemic were very different in rural Iowa than they were in urban areas and other parts of the country. Tell me a little bit about what you experienced early on in Lucas County.”
Cohen: “You know, you're reading the news and you're seeing things on TV. And certainly, in the beginning, this was very, very scary in New York and some of the bigger cities. But in rural Iowa you're being told all of the sudden things have to shut down, but you don't see it. We didn't have any cases in Lucas County until May, and once we did, it was very obvious they were very different from anything we'd ever seen before. But by then we'd been closed down for two months, and you have people saying, ‘This isn't real.’ ‘This isn't serious.’ ‘It's not going to affect rural Iowa the same, because we're not all that concentrated, so this is only going to be a city disease.’ And I think that really set the stage for what happened afterwards.”
“Tell me what's going on in Lucas County now, fast forwarding over a year later.”
“Fast-forwarding, now we have a situation where a whole lot of people never bought into this, so we have a vaccination rate that's about 42 percent — it was only 37 percent so we've made some progress — but it's only 42 percent. We've had a vaccine now for — what is it? Eight, nine months? We have people getting sick left and right now. We now have multiple cases every single day, even in small town Iowa, and we still have people who come in and say, ‘I don't need a vaccine.’ ‘I don't need medication.’ ‘I don't trust this.’ ‘This happened too fast.’ Or they buy into some of the conspiracy theories, like it has a chip in it, and they're going to track us. I think you know what, you're watching people get sick, they're frequently looking for some of the buzzword treatments, the remedies that are out there that are not proven, and in fact, frequently, are toxic to them. And so they come in sometimes too sick and too late to help them with the things that we actually know help, and there are things out there, like the antibody cocktails, those work those keep people out of the hospital, but you have to do it in the first seven days, and they're not coming in then, they're coming in later.”
“So we had this idea, I think, that you know there was that early distrust of the vaccines that was pretty widely seen. And I remember having conversations about how family physicians are going to be the key to convincing people to get vaccinated, to help them understand that because family physicians are people that are trusted by their patients, and that has been your experience in your career. Right?”
“Absolutely. I've been in Lucas County now for over 27 years. I have a very busy practice. I've done everything from delivering babies, to nursing homes, to emergency rooms to the hospitals to the office. And so, yes, I have people who are longtime patients for decades at this point, and I speak all day long, trying to convince people what the real truth is, trying to give them the best information possible so they can make good choices. It can be very frustrating because, as much as you know what the real numbers are, they don't believe it. They don't want to believe it. They're getting their information from other sources. And even though they trust you with their diabetes and their high blood pressure and even their lives, as soon as this topic comes up, a wall goes up, and you're lying to them. Or it's ‘a hoax,’ or ‘we've been lied to,’ or ‘it's a government conspiracy.’ And it's very hard to help people who aren't open to that kind of help.”
“Have you ever encountered anything like that in the past?”
“No, never in my career this kind of thing. This isn't my first pandemic. I was trained in New York during the HIV pandemic, so I understand what it is to have a serious illness out there. And I understand what it is for people to not understand it and to believe all kinds of things about it. But I've never seen where they wouldn't take that information and change how they look at things. This is very different from that. Somehow we allowed this disease to divide us in ways that we've not been divided before, and it has crippled our response.”
“How common is that among your patients? I'm sure it's not every patient, and, obviously, I'm not asking you to breach any kind of confidentiality, but can you give me an idea of just how prevalent this mindset is in Lucas County?”
“I have 42 percent of our county vaccinated. There’s probably been somewhere between a third and a half of the people have gotten COVID at some point or another in the last year, whether they knew it or not, depending on their symptoms.
“But I still see somewhere between five and ten patients a day who still don't think that this is something serious that they need to worry about. That the vaccine isn't safer than actually getting the disease, who still believe things that are clearly not true. I've had days in the not-too-distant past, where I've had up to four people over the age of 75, all of whom refused the vaccine, all of whom I spoke to at length about the fact that you have a 30 percent or 40 percent chance of dying of this disease, and probably a 60 percent to 70 percent chance of ending up in our hospital, and they still believe that it was better not to do something than to do something, even knowing those things, or at least hearing them from me. So it's, it's remarkably common, even in people that we know are high risk in southern Iowa and in rural America in general.”
“As a physician, how does that feel to you? Again, this is unprecedented in your career. What is that like to try to convince people that you have a relationship with — people that you care about — to do the right thing for themselves and of course for the people around them, but even just to save their own life?”
“For me, it's just terribly sad and frustrating. I look at these people, and I say they've been brainwashed. And I can't help them to save themselves. I can't help them to keep themselves from getting sick in a chronic way that may never go away, even if they do survive.
“We know this disease, it doesn't kill everyone. That's not the kind of disease it is. But it maims a lot of people. Twenty-five percent of the people who get this disease will still have at least one symptom six months from now, and some of them may never go away. And it's hard to make that real for people who have been brainwashed, quite frankly.”
“You have experienced COVID in your own family. So, both as a physician and, just as a person, you've had up close and personal experience witnessing how dangerous this viruses.”
“I've had a couple of my children, I've had one child and one on daughter-in-law and one son-in-law who've had COVID. My daughter and son–in-law have both had it twice. They had it very early in the pandemic, in March or so. And then again, late last October, they got it a second time. My daughter got long COVID from it, she had headache all the time. She had joint aches. She had problems. She was coughing and couldn't exercise and was short of breath, most of the time, and she was 25 and healthy. This was a normal healthy person. She lost her sense of taste and smell for three months. Most of that came back, although for most of the year she was still smelling things that weren't there and not smelling things that were. Fortunately for her. She is a coffee-holic, and she did get her ability to get to taste and smell coffee back, because that was very important.”
“Interestingly, when she got COVID the second time, her symptoms all got worse. And she was going to specialists because specialists didn't want to believe that she had long. And finally, I read a small article that suggested that those people who have long COVID symptoms, if they got the vaccine, they would probably get fairly severe side effects from it. Nothing life threatening, but more than the average person. But that 40 percent of them would improve or completely go away. And so she got vaccinated, one, because she didn't want to get it a third time and knew what was out there. And two, because she wanted some chance of getting rid of her symptoms. And in fact, after having symptoms from the vaccine that lasted a week or two. Three weeks later, all of the symptoms of long COVID went away. Everything. And, honestly. We're all grateful for that. She's kind of like the poster child for vaccination for long COVID.”
“As you mentioned earlier, COVID has come to rural Iowa and rural areas of the country, and in some places, in a really, really heartbreaking way. Tell me about the losses that you're seeing in Lucas County from COVID.”
“Those have changed a bit. We don't see as many deaths now, but they're not the same. Early on in this pandemic, most of those deaths, not all but most of those deaths, were people in their 60s or above. And we now know that the average age in hospitalization is 41, and we haven't had a lot of deaths, but we have had a pregnant woman who had an emergency C-section to cut the baby out. The baby lived, but she died. And to me that's tragic. It's sad, it's preventable. This didn't have to happen. The chances are so much better that had this person been vaccinated, they might have still gotten COVID, but the chances are very good, she wouldn't have ended up in the hospital. And she certainly wouldn't have died and left a child that's orphaned now, that will not have a mother. And to me, as a physician that's just... it's awful. It's an awful feeling that you can't help some of these people, and that such awful things were preventable but still can't be stopped.”
“I mentioned earlier that we are seeing this wave of people who wind up in a COVID ward in the hospital and are dangerously ill, making these videos, sending out messages saying ‘I wish that I'd gotten vaccinated. I wish that I had known.’ And it starts to feel — I mean, it's really demoralizing in so many ways — but it starts to feel like people aren't going to believe it until it happens to them. I also feel like a lot of people aren't sharing their COVID experiences because there's some kind of stigma or shame attached to getting this virus that so many people don't believe is real. Do you find that the people who have COVID in Lucas County are not telling others about it?”
“I find a mix of things there. There are the ones who get COVID, who don't want to acknowledge it. Their symptoms aren't that severe. They know they were exposed. They know they have symptoms. They don't want to miss work, and they continue going to work. There are others who get COVID and don't want to say anything because their church will shun them. I've had people who have been vaccinated because their jobs required it and then were shunned by their church. And I just don't understand that. It has become a dividing point for things that, that people shouldn't have to be afraid that the people they are closest to or the people of faith that they depend on will treat them differently because of a disease.”
“That's so interesting that a church would shun someone on the basis of vaccination because there are very few organized religions that reject vaccination, as a practice. This is so different.”
“I don't understand that because, almost certainly, all of those people had their childhood vaccinations. Many of them probably had the flu vaccine, but somehow this vaccine has been looked at and treated differently in the minds of so many and even people of faith. And I don't understand why they would step in and say, ‘No, this is wrong. This is against God,’ or whatever. I've had people tried to tell me it's not really a vaccine. I've had people who tried to tell me all kinds of things about the vaccine that I know can't possibly be. And some of this has been promulgated by churches. I've had people who told me no, ‘I'm not going to do that because it will change my DNA and I won't be conservative anymore.’ I've had people say it's all a government conspiracy to control our population and make women sterile. And it all seems to come back to misinformation and brainwashing that comes at people from so many directions that then, they don't know who to trust. They don't know who to believe. And so they believe what they want to believe.”
“You sound so tired, frustrated and fatigued, just in this moment. When you think about the future, what are you worried about with this incredible lack of trust that we're seeing right now? Do you feel like this changes things beyond COVID-19, if we ever get beyond it?”
“I think it's obvious that it changes that. It's because it has changed the doctor-patient relationship. There's so much trust necessary for people to put their lives in my hands, for people to trust that I'm going to give them information that that is in their best interests. And when you introduce doubt into that, what happens when they get other serious diseases? They may be late in getting help for things that were also preventable, fixable, treatable, whatever. And so it's obvious to me that this changes a great deal in our healthcare system, as well as the doctor-patient relationship.
“I look around me. and I see doctors and nurses who are leaving because they're done. Because they don't feel that they can do anymore what they needed to do for people. Or they feel that they've been betrayed by our country. Or they feel that they've been forced into things. And in some ways, sacrificed by our country to do things that they shouldn't have had to do for so long.”
“Do you feel like giving up?”
“No, I'm not one of those people. I am a survivor in that respect. I'm fortunate in that I don't feel burnout in the same way. I feel the need to go out and talk. I feel the need to communicate to other people the best I can, and I don't give up. I have seen other things in my life that are more than a little challenging. And those things have helped me to overcome these kinds of challenges.”