Increasing numbers of pediatricians are dismissing families that refuse vaccines for their children – due to frustration with uncooperative parents and fears about contagious kids in the waiting room. But should they? This week, University of Pennsylvania bioethicist Arthur Caplan urged doctors not to give up on them.
“Ethically, I think I understand why doctors may say, 'Look, I don't want to deal with nonvaccinators. It's poor practice, it puts people at risk in my waiting room, and I'm not going to do it,' " Caplan said in a video on Medscape.com, a medical-news website aimed at health-care practitioners. [You’ll have to register – it’s free — to see the video.] “But that gets these parents into the office, and you may have a chance at persuading them to vaccinate their children. I am going to argue that it is important to try hard, to not dismiss these people but stick with them to see if you can persuade them.”
As a small yet growing group of parents refuse childhood vaccines, more doctors are standing their ground. Big reasons parents say "no" include worries about the rising number of recommended vaccines for kids, continuing fears about autism and vaccines (despite a lack of research evidence), and fall-out from the 2000 controversy over thimerosal preservative in vaccines.
The American Academy of Pediatrics, the American Medical Association, and the Centers for Disease Control and Prevention all recommend kids’ doctors keep caring for these families. But half of the pediatricians in one national study said they had families decline vaccines – usually due to safety concerns. And 28 percent said they would dismiss patients whose parents chose to skip recommended shots.
In a 2011 study of 133 Connecticut pediatricians, 30 percent said they have “fired” families over vaccines. The study also found that more and more doctors are dealing with the issue. Overall, 83 percent had families who said "no" to some vaccines and 60 percent said they had at least one family decline all vaccines in the previous year.
The researchers say insurance-company rules may be playing a role. “Health maintenance organizations have started to include vaccination rates as part of their pay-for-performance programs that reward physicians financially for meeting certain benchmarks, including childhood immunization rates,” they note. “This practice may financially penalize physicians with larger numbers of undervaccinated children.”
What do you think? If you have vaccine concerns or have refused vaccines, how did you and your doctor handle the situation?