There are many reasons people don’t want to get the COVID vaccine. If you’re Dr. Peter Van Houten of Sierra Family Medical Clinic, you’ve heard them all. His Nevada County clinic is located on the San Juan Ridge, an isolated area known for its off-the-gridders, cannabis farmers, and anti-authoritarianism. So it was surprising when state health department data from late May showed that “The Ridge” has some of the highest COVID vaccination rates in the county (74 percent, compared with 55 percent in central Nevada City.) Nevada County health officials credit Van Houten’s pioneering use of psychotherapy techniques. His methods also won him the “Rural Champion” award from the California State Rural Health Association in 2009. We chatted with Dr. Van Houten to find out how he uses gentle questioning to win over the vaccine-hesitant.
This interview has been edited for clarity.
What are the main reasons patients don’t want to get the COVID vaccine?
For some of my [lower-income] patients, their lives are pretty dysfunctional, and it can be hard to get it together to come to a medical appointment. For them, we say, “We’re giving vaccines today. Can we give you one after your visit?” Others want to make sure the development of these vaccines wasn’t overly rushed, and that we know what the side effects will be. Then there are people who are opposed to the idea of vaccines in general.
How do you approach these conversations?
I always just start simply with everybody and see if I can understand if they have vaccine hesitancy, what is that about? Is that something that I can simplify or answer? Often if we can, they are quite willing to move forward. But you have to practice what we call “being curious” about the patient. You can’t just say, “If you don’t get a vaccine, then get out of my office!”
What does “being curious” look like?
We ask them gentle questions, in what’s called “motivational interviewing.” It’s an elegant approach that’s about friendship and compassion rather than just delivering information. For instance, if they express vaccine hesitancy, I might say, “Can you tell me why, so I can understand it?” And when they answer, I say, “I hear what you’re saying and I’m glad you’re interested.” Then I ask their permission to give them some more information.
How did you develop “motivational interviewing” in your medical practice?
Two years ago I completed a Psychology and Primary Care fellowship with UC Davis. One of the things they said was, “You know the kind of patients where, when you see them on the schedule, you groan? The ones where you’re thinking ‘I can’t believe I have to see this patient because I know how difficult they are’? When you get good at motivational interviewing, you will look forward to seeing them, because you will help them get unstuck. It will take the combativeness out of the relationship.”
Does it take the combativeness out of the relationship?
They realize you really care about them as humans, and it creates an openness where we can make some gentle suggestions. You develop a collaborative buy-in, where you and the patient together are agreeing.
What about patients who believe information sources that contradict mainstream medical advice?
Pretty much what I try to do is leave the door open. I let them understand that it doesn’t mean we can’t be friends and we can’t help you in other ways, even if we don’t agree.
You’re a leader in the spiritual intentional community, Ananda Village. Does this influence your medical practice?
It was one of the reasons I wanted to start a healthcare facility out in this area, to serve our neighbors, about 40 years ago.
Do you think you’ve been instrumental in influencing relatively large numbers of people on The Ridge to get the COVID vaccine?
We’re finding that people are encouraged the most by having a neighbor, friend, or family member share that they’ve been vaccinated and are doing well. This community talks to one another. So we’ve started asking our vaccinated patients to tell just one person about their experience. We’re calling it our “Each One, Reach One” campaign. If we all just tell one person, I think we’ll have some semblance of herd immunity.
Photo by Barbara Bingham Photography.
