We live in an age of “pragmatic expertism”, assured we can justify any action based on an ‘expert’s opinion’, a worldview where the end justifying the means. In the case of flu shots being offered in an ER setting, this means that because our CDC believes everyone should be vaccinated… therefore encouraging patients waiting in an ER to take a flu shot is a good thing. There is a time and a place for any given medical procedure. There is a process of informed consent for any given medical procedure. There is a need for a trusted provider to discuss the appropriateness of any given medical procedure with the individual patient without coercion. Flu pokes in the ER does not satisfy any of these criteria.
Imagine yourself coming into the ER at 11PM with vomiting and diarrhea or a possibly broken ankle. You are waiting in the waiting room, in significant discomfort no matter how you sit, whether it’s your stomach or your ankle or something else. Staff comes up to you, possibly the receptionist, and asks, “hello, while you are here, have you had a flu shot this year? We can take care of that for you if you want.” Of course, this first time we can easily say “no thanks” and hold our breath while the reflexive “but it’s a good thing for you and your grandma and your neighbor if we all get flu pokes” echo in the waiting room for the 100th time that night.
Okay, maybe you actually make it back to an exam room and the technician or the nurse brings it up instead (or again, if you already heard the first pitch). Now we at least have medical personnel addressing you with the offer. However, it is an ER whose very design is speed and efficiency to avoid waiting room congestion. Again, it is just a question and encouragement followed by a sideways smirk or under the breath, “Oh, one of them,” when you repeat, “No thanks.” Everyone expects you to just roll up your sleeve and take a poke for the team, to smile and say yes without any questions.
Let’s step back and consider this from a simple truth-in-advertising point of view. Does any of the staff go beyond the script and explain how the flu pokes usually have less than 50% efficacy, can increase risk of other viral illnesses, or cause allergic reactions in some? Oh, don’t forget the studies that suggest decreasing efficacy as one gets more and more pokes each year. Surely they know all this?
The study I’ve cited below urges just these type of measures in the ER. The researchers are quite proud of their findings and how it could improve flu poke uptake in under-served populations. Pragmatic expertism is working at its finest here. Here’s the pitch: disregard the need for true informed consent in giving a potentially life altering medical procedure, let alone advice from a trusted medical provider, and just trust the experts selling their pharma.
Helping our patients and the public live healthier, more abundant lives means helping you to think critically and courageously about your medical decisions. Push back against pragmatic expertism by saying ‘No’ to one-size-fits-all medicine.
Focus article:
Robert M. Rodriguez, Stephanie A. Eucker, Zubaid Rafique, Graham Nichol, Melanie F. Molina, Efrat Kean, Kelli N. O’Laughlin, Sarah K. Bezek, Karina Goicochea, James S. Ford, Dana Morse, Jaran White, Mireya I. Arreguin, Lindsey Shughart, Cecilia Lara Chavez, Dave V. Glidden, Kristin L. Rising. Promotion of Influenza Vaccination in the Emergency Department. NEJM Evidence, 2024; 3 (4) DOI: 10.1056/EVIDoa2300197
Thanks to Science Daily:
University of California – San Francisco. “Just ask: Patients in the ER are willing to get a flu shot.” ScienceDaily. ScienceDaily, 26 March 2024. <www.sciencedaily.com/releases/2024/03/240326170037.htm>.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.