An increasing number of parents are refusing to have their children vaccinated according to the schedule recommended by the CDC, opting to delay some vaccinations, refuse specific vaccinations or refuse all vaccinations. According to recent surveys and experiences, making a decision that they feel is best for their children may put these parents at risk of not having access to healthcare for their children.
How many parents request an alternate vaccination schedule?
An AAP study published in October 2011 reported on the Alternative Vaccination Schedule Preferences Among Parents of Young Children. It found that:
Of the 13% of parents who reported following an alternative vaccination schedule, most refused only certain vaccines (53%) and/or delayed some vaccines until the child was older (55%). Only 17% reported refusing all vaccines.
Ultimately, this shows that the number of parents who are outright refusing vaccines for their children is still very small (around 2.2%) and most parents are only requesting slight variations to the recommendations. In addition, the study also found that not all parents who do follow the recommended schedule are necessarily confident that it is the best approach:
Among parents following the recommended vaccination schedule, 28% thought that delaying vaccine doses was safer than the schedule they used, and 22% disagreed that the best vaccination schedule to follow was the one recommended by vaccination experts.
Some may follow the recommended schedule in spite of their doubts because they don’t want to create a rift in the doctor/patient relationship or because it is more convenient to follow that schedule (lots of shots at one appointment, versus a more spaced out approach).
How many doctors are kicking patients out of their practice?
In October, Kristina Chew wrote on Care2 about a Pediatrics study that found that 61% of doctors were willing to delay or space out vaccinations. Another recent study published in the Public Health Reports Journal found that more than 30% of doctors have dismissed families from their practice because they refused vaccinations.While the former study states its findings in a way that suggests doctors are accommodating, the latter one (with results that are quite similar to the first) suggests that close to one third of doctors may be refusing to treat patients who question vaccination schedule.
Although the AAP does recommend that children be vaccinated according to its schedule, it also advocates against discharging patients if they disagree with that schedule. The following excerpts from the AAP’s policy paper on Responding to Parental Refusals of Immunization of Children clearly show that those families should still have access to adequate medical care:
Continued refusal after adequate discussion should be respected unless the child is put at significant risk of serious harm (as, for example, might be the case during an epidemic). Only then should state agencies be involved to override parental discretion on the basis of medical neglect.
In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child. However, when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice. Although pediatricians have the option of terminating the physician-patient relationship, they cannot do so without giving sufficient advance notice to the patient or custodial parent or legal guardian to permit another health care professional to be secured. Such decisions should be unusual and generally made only after attempts have been made to work with the family. Families with doubts about immunization should still have access to good medical care, and maintaining the relationship in the face of disagreement conveys respect and at the same time allows the child access to medical care. Furthermore, a continuing relationship allows additional opportunity to discuss the issue of immunization over time.
In 2010, blogger Tiffany Washko wrote about her experience with one of the doctors who fires non-vaccinating families. Washko, whose older son was injured and almost killed by a vaccine (as confirmed by two pediatric neurologists) and who was told never to vaccinate him again, relayed the experience she had when her family visited a new doctor after moving:
This new doctor, who has never met my older son and has never looked at his medical history said this was all lies. Either I was lying or these doctors were quacks.
I was quite angry after that and went on tirade about vaccine risks. The doctor replied that vaccines have NO risks. ZERO risk. At that point I started to think the man was a blooming idiot. I politely asked why it was that each vaccine comes with an insert outlining all the CONFIRMED risks associated with each vaccine as documented in drug trials. His response…the flyers are full of made up stuff so that vaccine companies can cover their bases. Really? Death is listed as a risk just for kicks and giggles? Yes, despite this man’s medical degree he was an idiot…who had clearly never researched vaccines beyond the one week he went through them in class or the indoctrination he managed to absorb at medical conventions.
I asked why he felt that refusing to see unvaccinated kids was ethical. Did they not deserve medical care? He declared that medical doctors are banding together and refusing to see these families because they feel it will force parents to reconsider their bad choices. Oh blackmail? No, he said with a smug smile, it isn’t blackmail if what they are doing is BEST for the children. Wow…
The amount of disdain that some doctors show towards their patients is incredible. They seem to assume that patients who have made the decision not to vaccinate or to request an alternative schedule, are simply uneducated, despite the fact that very highly regarded pediatricians such as Dr. Bob Sears recommend an alternative schedule.
Interestingly, the Public Health Reports study found that “suburban physicians caring for wealthier, better educated families, experience more vaccine concerns and/or refusals and are more likely to dismiss families for vaccine refusals.”
How far will doctors go?
Some doctors cite concerns about unvaccinated patients infecting not-yet-vaccinated babies in the waiting room as a reason for refusing to see families that delay or refuse vaccinations. How logical is this? Currently, almost all families do follow the childhood vaccination schedules. However, fewer than half of Americans get the annual flu shot. Doctors continue to see and treat flu patients in their practice, despite the fact that it is a contagious disease that the CDC says leads to between 3,000 and 49,000 deaths in the United States each year. If doctors will “fire” patients for refusing the HPV vaccine, will they soon start “firing” patients who do not come in for their annual flu shot?
Photo credit: KOMUnews on flickr
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