Considering the weight of the evidence
that vaccination is safe, and the weakness of studies
which have suggested otherwise, it's not surprising
that some doctors may feel a little impatient with parents
who fall for media scaremongering on immunization. What
is surprising is the number of physicians who take the
step of dismissing parents for refusing to have their
kids vaccinated. A recent survey published in the October
issue of Archives of Pediatrics & Adolescent
Medicine asked 302 US pediatricians whether they
would refuse to deal with families that refused one
or more vaccines. An astonishing 39% said they would
refer any family that refused all vaccines to another
doctor.
A further 28% said they would dismiss
a family that accepted most vaccinations but refused
only one, or even a family that just asked for a delay.
Dr Erin Flanagan-Klygis, a pediatrician at Chicago's
Rush Medical College and the lead author of the paper,
said her team was taken aback by the response. "We did
not expect this high a number," she said.
The reason, respondents said, was
that this would indicate a lack of shared goals and
of trust in the physician's judgement. Fifty-four percent
of them had faced a total vaccine refusal in the previous
12 months, while 85% had seen a single-vaccine refusal.
GAUGING
DOCTORS' FEELINGS
The harsh attitude shown by so many of these pediatricians
is all the more surprising because it flouts guidelines
put out by the American Academy of Pediatrics. These
guidelines urge doctors not to dismiss patients over
vaccine refusal unless there are huge differences in
philosophy of care, a breakdown in communications or
a "substantial level of distrust."
The Canadian Paediatric Society,
meanwhile, has no such guidelines and refuses to take
a position on the issue. "I don't think turning away
patients for vaccine refusal would be considered ethical
here," says Dr Aline Rinfret, vaccine specialist at
the Canadian Public Health Agency.
The Canadian Immunization Guide,
issued by the National Advisory Committee on Immunization,
devotes several pages to techniques doctors should adopt
in persuading reluctant parents, and even offers advice
on dealing with the media. But it is silent on the issue
of dismissing patients.
"All the pediatricians I've spoken
to said they would rather keep these families, and try
to persuade them of the benefits," said Mary Appleton
of the Canadian Coalition for Immunization Awareness
and Promotion. "But there is a lot of frustration with
the misinformation out there. In the limited time available
for pediatricians' consultations, it isn't always possible
to correct it, and that leads to frustration."
Doctors are the only ones who can
counter the misinformation, says Dr Flanagan-Klygis.
But she hesitates to condemn doctors who 'fire' patients,
saying "[Dismissal] is one way pediatricians express
their frustration with that situation." She has never
dismissed a family herself, and neither have her two
co-authors. "When the patient is gone, they are gone."
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