You will hear those who study science denial and other social psychology phenomena discuss the role of the Dunning-Kruger effect in contributing to a person’s ability to believe in, as H. L. Mencken stated, “the palpably not true.” How can people believe so confidently in an idea that has an overwhelming amount of evidence against it (that the Earth is flat, that climate change isn’t real, that vaccines cause autism)? The Dunning-Kruger effect is an effect that both those with little knowledge and those with a considerable amount of knowledge fall victim to. Essentially, it is the observation that people with little expertise or ability often evaluate themselves as having superior expertise or ability. They “don’t have enough knowledge to know they don’t have enough knowledge.”¹ Moreover, the opposite can be true for people with superior ability and expertise. They tend to underestimate their ability and expertise because they have enough knowledge to know that there is a lot they don’t know.

This effect is at play when we or our colleagues suffer from imposter syndrome, where we undervalue our competency and feel like a fraud. As physicians and advanced practice providers, scientists, and other health officials, we know a great deal about our fields of study, but we also recognize how much there is that we don’t know. This can cause us to doubt ourselves. “If there’s so much that we don’t know, how can we feel confident in what we say and in the advice that we give?” we may wonder. We often feel at risk of being “found out,” that somehow someone is going to figure out that we really don’t know what we are talking about. This syndrome can lead us to avoid speaking up and speaking out for fear of being “discovered.”

Prior to reading this book, you may have doubted your expertise and lacked confidence in your ability to speak with authority about the safety and efficacy of vaccines. You may have shied away from encouraging your vaccine-hesitant patients to have discussions about their concerns. You may have defaulted to the “just let it slide” approach with patients who have previously declined vaccinations. In this book, I have provided tools to help you through these challenges. I have reviewed the history of vaccines, vaccine-preventable diseases, anti-vaccine sentiment, the psychology at play in the anti-vaccine movement, and the robust system of checks and balances designed to ensure vaccine safety and efficacy. I am hopeful that, with this new knowledge, you have gained further trust in our vaccine recommendations as they stand. I have also offered proven interviewing techniques and data-driven responses to the many questions and concerns that you get from patients, as well as information you can use to help your patients better interpret what they are reading online.
This information should grant you greater confidence in your expertise and ability to educate your patients with accurate information, while maintaining a strong relationship and feeling that you are “on the same team,” even if you ultimately have to agree to disagree.

It’s important to remember that the old adage, “If at first you don’t succeed, try, try again,” still stands as sound advice. You may not change your patients’ mind the first time you have the conversation, or the seventh time. But eventually, with persistence and an honest expression of caring and concern for your patients’ well-being, at least some of those who initially decline vaccines will come around. Douglas Opel et al. studied a group of pediatricians during vaccine counseling interactions with parents of 1- to 19-month-old children who were being seen for health supervision visits. Of parents counseled about vaccines who initially declined immunizations for their child, 47% of parents eventually agreed to vaccination if their provider persisted with a strong recommendation.² It goes to show that if we have confidence in our ability to make an impact, and we continue to educate, counsel, and offer strong encouragement for immunization, we will find greater successes in getting our patients vaccinated (Box 15.1).