Is it appropriate for a physician to dismiss a family for refusing all vaccinations?
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Volume 39, Issue 11, Page 23 (November 2005)
Karen E. Breach, M.D., is a pediatrician in Charlotte, N.C.
It's appropriate to dismiss a family from your practice when it disrupts
the physician-patient/parent relationship. It comes down to a matter of trust.
If the parents don't trust the physician on an issue as important to a
child's health as immunization, they are more likely to question the
physician's judgment about other important health concerns. This can lead to feelings of mistrust on the physician's part about parental compliance with other prescribed treatment.
I don't generally see a lot of families who refuse vaccinations. However,
when it comes up, I discuss it with the family and offer them written
materials or Web sites to consider later at home. I try to give them time
to think about their decision. In some cases, I've given families a year to
consider their options. However, as a matter of office practice, I do
require that parents sign a waiver of vaccine refusal for state-required
vaccines at each recommended interval.
I try to be flexible about the timing of the immunizations. There are
parents who feel the need to delay the first hepatitis B vaccine in the
nursery. Some parents have expressed concerns about the connection between the MMR vaccine and autism. I explain to them that the vaccine is safe and that the symptoms of autism often appear around the time that the first MMR vaccine is given. If they have concerns, I will let them delay the vaccine for a year so they can see whether their child shows any signs of autism without the vaccine confusing the issue.
Some families have genuine concerns that can be allayed when I take the
time to educate them. But, unfortunately, some parents aren't willing to
listen to scientific arguments.
The physician-patient/parent relationship shouldn't be a tug of war over
any issue.
When I am unable to feel comfortable treating a family, I try to refer them to another physician who does not feel as strongly as I do about
immunizations. In my 10-physician practice, 1 or 2 of my colleagues would be comfortable seeing these families.
I feel passionately about the need to immunize all children. During my
residency training and earlier years of practice, Haemophilus influenzae
type B was the most common cause of invasive bacterial disease in infancy and early childhood. I treated numerous cases of cellulitis, pneumonia, epiglottitis, and meningitis caused by H. influenzae B. I saw children suffer permanent neurologic sequelae from the disease or the antibiotic used to treat it, and I have seen death. I am happy that, because of vaccinations, my younger colleagues have never seen this disease and probably never will.
With each vaccine advance, I feel more strongly about my responsibility to protect children from truly preventable diseases.
