My patients will tell you that I am pretty laissez faire as doctors go. I have enough respect for people's ability to make good decisions about their own lives and enough humility about the limits of medical certainty to support my patients' choices- even when they choose not to follow my recommendations. When a patient says ‘no thanks' to a cholesterol lowering medication or skips a mammogram I try to understand their reasoning, supply information about the possible negative consequences of the decision but I don't berate them. My feeling is that if I did berate them it would only injure our rapport and make them less likely to visit me again or confide in me and that - more than any missed test or untaken prescription -would be harmful to their health.

Lately, though, about one issue in particular, I've been getting a little more, shall I say...assertive. A recent National Foundation for Infectious Diseases survey estimated that half of eligible Americans do not intend to get flu shots this year - a year when the emergence of H1N1 or swine flu threatens to make this the worst flu epidemic in terms of incidence, hospitalizations, and deaths in half a century. Granted the roll out of H1N1 vaccine has been slow and even regular seasonal flu shots are in short supply in some areas (though both of these issues will be rectified in coming weeks) so some people actually haven't had the chance to turn down the vaccine. But, if my practice is any indication, they will. I have spent much office time lately having conversations about the vaccines with skeptical patients and finding myself becoming-uncharacteristically for me - more and more directive.