Pediatricians fed up with parents who refuse to vaccinate their children out of concern it can cause autism or other problems increasingly are "firing" such families from their practices, raising questions about a doctor's responsibility to these patients.
Medical associations don't recommend such patient bans, but the practice appears to be growing, according to vaccine researchers.
In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.
By comparison, in 2001 and 2006 about 6% of physicians said they "routinely" stopped working with families due to parents' continued vaccine refusal and 16% "sometimes" dismissed them, according to surveys conducted then by the American Academy of Pediatrics.
"There's more noise among pediatricians, more people willing to argue that it's OK to do this versus 10 years ago," said Douglas Diekema, a professor of pediatrics at the University of Washington in Seattle. Dr. Diekema wrote the AAP's policy on working with vaccine refusers, which recommends providers address the issue at repeated visits, but respect parents' wishes unless it puts a child at risk of significant harm.
Most pediatricians consider preventing disease through vaccines a primary goal of their job. The Centers for Disease Control and Prevention and AAP issue an annual recommended vaccination schedule, but some parents ask if their child's immunizations can be pushed back or skipped altogether, pediatricians say.
While rates for several key inoculations in young children rose between 2009 and 2010, according to the CDC, lower immunization rates have been blamed as a factor in U.S. outbreaks of whooping cough and measles in recent years.
Parents often voice concerns about autism or that their child's immune system may be overwhelmed by too many vaccines at once. Worries about a link between vaccines and autism arose because some parents noticed their children regressed, or lost some skills, around the time of their vaccinations at two years of age. Another concern centered on the former use of mercury as a vaccine preservative.
Numerous studies since have dispelled these concerns among scientists. Rather, scientists say, it is more likely that autism symptoms begin showing up around the same age children are vaccinated.
The rise in patient firings reflects another factor. As patients have become savvier and more willing to challenge doctors, physicians have become increasingly reluctant to deal with uncooperative patients, said Arthur Caplan, a bioethics professor at the University of Pennsylvania. In addition, doctors may feel financial pressure to see more patients and so have less time to contend with recalcitrant ones.
For Allan LaReau of Kalamazoo, Mich., and his 11 colleagues at Bronson Rambling Road Pediatrics, who chose in 2010 to stop working with vaccine-refusing families, a major factor was the concern that unimmunized children could pose a danger in the waiting room to infants or sick children who haven't yet been fully vaccinated.
In one case, an unvaccinated child came in with a high fever and Dr. LaReau feared the patient might have meningitis, a contagious, potentially deadly infection of the brain and spinal cord for which a vaccine commonly is given. "I lost a lot more sleep than I usually do" worrying about the situation, he said.
"You feel badly about losing a nice family from the practice," added Dr. LaReau, but families who refused to vaccinate their kids were told that "this is going to be a difficult relationship without this core part of pediatrics." Some families chose to go elsewhere while others agreed to have their kids inoculated.
Pediatricians disagree about what their duty is to these families. "The bottom line is you should try to do whatever you can to maintain the family in the best care," said Michael Brady, chair of the pediatrics department at Nationwide Children's Hospital in Columbus, Ohio, and a member of the AAP's immunization committee. "If they leave your practice, they're probably going to gravitate toward another practice with unhealthy practices."
Other physicians say they rarely have had luck persuading vaccine opponents to change their minds.
David Fenner and his 20-plus colleagues at Children's Medical Group in Rhinebeck, N.Y., discuss vaccine concerns but ask families to leave if they don't comply by a certain point.
Dr. Fenner said he tells new families, "You've been bombarded with information before you came here, some accurate and some not." Iif a family refuses to vaccinate after a discussion of the issue, he tells them "there are so many things we're not going to see eye-to-eye on."
So far, the practice has fired a couple of families per year since it implemented the policy about five years ago.
Pamela Felice, who lives in an Atlanta suburb, had difficulty finding a pediatrician for her two children though they have waivers from a previous pediatrician exempting them from school requirements for immunizations. Her older child had gastrointestinal trouble and regressed development after receiving vaccines, she said, which she believes were related to the shots.
Ms. Felice received a letter from her pediatrician a few years ago stating that because the family chose not to vaccinate, it needed to find another doctor. She called four or five other practices but none would agree to an appointment after she told them she was opposed to vaccines. The family ended up with an elderly family doctor who said he had "seen it all" and was willing to treat the children if they got sick, Ms. Felice said.
"A doctor should feel obligated to discuss [potential vaccine] risks with any parent who wants to discuss them," said Ms. Felice.
http://online.wsj.com/article/SB10001424052970203315804577209230884246636.html#articleTabs%3Darticle
What do you think?
I HATE former Dr. Wakefield! The UK ran him out on a rail. So did the US! I am okay with not vaxing, if you have religious or scientific data showing why. I delay vax, myself. But, for the love of all that is good and right in this world- everyone who supported Dr. Wakefield in his study on the MMR vaccine has said it was fraudulent and the parents of the children don't even support the study. He was trying to patent and market a competing vaccine, thus did not have pure motives and skewed data. : (
I don't personally want to have any kind of a relationship with a ped who feels it is HIS place to make MY family's decisions.
I wonder if private practice doctors are allowed to discriminate based on religion. For anyone using a religious exemption, that's what's happening.
If the waiting room bothers them, they should have separate areas for healthy and sick children. I've seen it happen, it's not far fetched, and should be done regardless, IMO.
When people start talking about the hundreds of concerns I have besides autism, I might start listening. Until then, this is argument is clearly the only rebuttal they have, and I'm not going to question myself.
I'm fortunate in that there's a clinic nearby so it's not crazy expensive, thank gawd. When I was interviewing peds I got kicked out before I could even finish asking about all my non-mainstream 'nonsense.'
It's worth the extra money to have a ped who respects my role as mommy. :)
Good luck, I hope that works out for you well and soon!
Quoting JoJoBean8:I've been waiting for my walking papers for awhile. They hate me at my kid's ped office. I told them I was waiting until age 2 to start vaxing when he turns 2 and I don't vax I'm sure I will be fired. When my DH gets a better job making more $ we plan to switch to a nauropath doctor.
I nod and smile and then do as I wish! They don't even know what they are talking about. Last visit they said that a 9 month old should be eating 3 meals and 2 snacks a day and if he wasn't I was giving him to much bm. They went on to say that bm is no longer a good source of nutrition at his age. My DH was so proud that I didn't punch the dr!
Quoting jellyphish:
I totally LOVE my naturopathic ped!
I'm fortunate in that there's a clinic nearby so it's not crazy expensive, thank gawd. When I was interviewing peds I got kicked out before I could even finish asking about all my non-mainstream 'nonsense.'
It's worth the extra money to have a ped who respects my role as mommy. :)
Good luck, I hope that works out for you well and soon!
Quoting JoJoBean8:I've been waiting for my walking papers for awhile. They hate me at my kid's ped office. I told them I was waiting until age 2 to start vaxing when he turns 2 and I don't vax I'm sure I will be fired. When my DH gets a better job making more $ we plan to switch to a nauropath doctor.
Quoting JoJoBean8:I nod and smile and then do as I wish! They don't even know what they are talking about. Last visit they said that a 9 month old should be eating 3 meals and 2 snacks a day and if he wasn't I was giving him to much bm. They went on to say that bm is no longer a good source of nutrition at his age. My DH was so proud that I didn't punch the dr!
Quoting jellyphish:
I totally LOVE my naturopathic ped!
I'm fortunate in that there's a clinic nearby so it's not crazy expensive, thank gawd. When I was interviewing peds I got kicked out before I could even finish asking about all my non-mainstream 'nonsense.'
It's worth the extra money to have a ped who respects my role as mommy. :)
Good luck, I hope that works out for you well and soon!
Quoting JoJoBean8:I've been waiting for my walking papers for awhile. They hate me at my kid's ped office. I told them I was waiting until age 2 to start vaxing when he turns 2 and I don't vax I'm sure I will be fired. When my DH gets a better job making more $ we plan to switch to a nauropath doctor.
Quoting jellyphish:
I can't do that though. First I wouldn't be able to keep myself from laughing. A lot. But also because I feel it's important my ped knows and respects my children's life style, especially if there's ever an emergency situation.
Quoting JoJoBean8:I nod and smile and then do as I wish! They don't even know what they are talking about. Last visit they said that a 9 month old should be eating 3 meals and 2 snacks a day and if he wasn't I was giving him to much bm. They went on to say that bm is no longer a good source of nutrition at his age. My DH was so proud that I didn't punch the dr!
Quoting jellyphish:
I totally LOVE my naturopathic ped!
I'm fortunate in that there's a clinic nearby so it's not crazy expensive, thank gawd. When I was interviewing peds I got kicked out before I could even finish asking about all my non-mainstream 'nonsense.'
It's worth the extra money to have a ped who respects my role as mommy. :)
Good luck, I hope that works out for you well and soon!
Quoting JoJoBean8:I've been waiting for my walking papers for awhile. They hate me at my kid's ped office. I told them I was waiting until age 2 to start vaxing when he turns 2 and I don't vax I'm sure I will be fired. When my DH gets a better job making more $ we plan to switch to a nauropath doctor.
I think that it is ok to talk to the family about the risks of not vaxing, but it really should be up to the parents. If the physician feels that they should overstep that decision and force a vac or dismiss a client, that is going to be his or her decision. My kids are not completly vaxed at the moment because when they started trying to push the H1N1 vax on my kids I stopped going there. We haven't found a doctor yet that we like so we are going to go to my doctors practice to see if they will see my kids. My kids were born while I was on PA, both times temporary, and the PA doc was never is, I ended up seeing someone different each time and the staff was rude. At least in my current office the physicians listen to me and they have this thing that a lot of doctors have forgotten about, COMPASSION. Find one of those and you might find a good doctor.
I was once given an info packet about bfing that babies need to be weaned to cow's milk BY 12 months or they will have their appetite spoiled by breastmilk. And apparently that is the current recommendation!
I haven't yet but I am still thinking about writing an angry letter to whoever approves those booklets. I wonder how many families have followed this advice without a second thought :(
Quoting JoJoBean8:I nod and smile and then do as I wish! They don't even know what they are talking about. Last visit they said that a 9 month old should be eating 3 meals and 2 snacks a day and if he wasn't I was giving him to much bm. They went on to say that bm is no longer a good source of nutrition at his age. My DH was so proud that I didn't punch the dr!
Check out some of the top posts today in Groups:
Babywearing around the world
- Mrs.Salz
on Feb. 16, 2012 at 10:50 AM