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Do you ‘fire’ patients whose parents refuse vaccinations?
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If vaccine refusal is absolute, we ask parents to find another health care provider.
We have taken a very proactive approach toward vaccinating all of our patients. We begin with the prenatal visit, where our vaccine policy is handed out to all prospective patients and continue at each well check, where the benefits of vaccines are discussed and parents are prepared for what to expect at the next visit.
This certainly is a conversation, though, and not a lecture. We are often asked to spread the vaccines over several visits or to delay vaccines until a later age. Most of these requests stem from misinformation or lack of information on vaccines, and we therefore make every effort to educate our parents. While we do our best to keep to the vaccine schedule, we do work with parents who agree to the vaccines within a reasonable time frame because, ultimately, vaccination and promoting health are our main goals. Parents who skip certain vaccines or delay vaccinating are asked to sign “refusal to vaccinate” acknowledgements.
With respect to the influenza vaccine, we certainly don’t “fire” patients whose parents refuse the vaccine. We recognize parents’ general reluctance to vaccinate older children, for whom we have never recommended the vaccine before this year. We spend the time trying to educate these parents on the reasons behind the recommendation for vaccinating all children and how the influenza vaccine will benefit the health of their child as well as the public in general.
But if a parent absolutely refuses all vaccinations, then we ask them to find another health care provider who shares their beliefs. This is done only after urging them to consider the risks they are taking with their child’s health. One of my mentors taught me long ago that vaccine refusal is often only the first step in a one-sided parent-physician relationship, where our experience, training and expertise are disregarded. By acquiescing to parents’ demands against our better judgment, we not only deny ourselves any partnership in promoting the patient’s health, but assume tremendous liability when health fails. This holds true for vaccines, antibiotics and any advice we may dispense during office visits. Such relationships are unproductive and unsatisfying for parents, patients and physicians alike and undermine the promotion of effective health.
Bradley J. Dyer, MD, FAAP, pediatrician at All Star Pediatrics, Exton, Pa.
We listen to and respect their concerns, but we do not refuse them care.
I think parents have a duty to vaccinate their children, both for the good of the child and for the good of the community. They have a duty to prevent their children from spreading disease to other people (some who may not be able to get vaccinated for medical reasons). Parents may choose not to carry out that duty, which raises the question of how physicians and schools should respond to their decision.
Schools can reasonably exclude children who remain unvaccinated from attending school during influenza season because those children pose a risk to others and because an influenza outbreak can be very disruptive to the educational process.
The role of the physician is to encourage vaccination, to provide honest and data-based information on the vaccine and the disease it prevents, and to vaccinate children with the consent of their parents. If the physician is faced with a parent who is reluctant to vaccinate against the influenza virus, he or she should listen carefully and respectfully to their concerns and attempt to address those concerns.
For those parents who persist in their refusal to vaccinate a child against influenza, it seems counterproductive to “fire” them from the practice. First, by doing so, the physician loses any opportunity to continue to work toward vaccination with that family. People do change their minds, and they are more likely to do so when treated respectfully by a trustworthy physician than they are by having the clinic door slammed in their face.
Second, the person who suffers the consequences of that decision is the child who no longer has that physician as a source of quality health care. There is no guarantee that the parent, in looking for a replacement provider, will seek care from someone who can offer the same level of care.
Douglas S. Diekema, MD, MPH, of the Treuman Katz Center for Pediatric Bioethics and of the Department of Pediatrics at the Seattle Children’s Hospital.