Pediatircians "friendly" to Anti-Vaccine Folks

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So, I started researching on the nurse midwife from the Hopkins verdict post, and I ended up stumbling on one of those crockpot naturopathy/homeopathy forums. I apparently thought my blood pressure was too low, because I decided to look through the forum and read a bit.

Here's my question -- there are a lot of posts asking about "non-vax friendly" pediatricians -- aka peds docs who won't counsel the mothers that they're making the wrong decision if they don't seek vaccinations. Some of the docs described simply allow non-vax patients in their practice (a mistake, imho), but many of the posts describe docs who don't even question their decision not to vaccinate their children.

My question: isn't this malpractice? I mean obviously if the mom says no to vaccines despite whatever you tell her, there's nothing you can do (unfortunately, though I think it's a CPS issue) -- but not even counseling the mother that she needs to vaccinate her children and explaining the extraordinary risks of not doing so? How is that not malpractice?

I apologize for the slightly emotional post, but these kinds of things make my blood pressure skyrocket. It's one thing to do something stupid with your own body, but the decisions these parents are making for their minor children...

Fire a non-vaccinating parent (and kid) from the practice in an urban clinic... you never see the patient again. Sometimes some care is better than no care, unfortunately.

I think you'd be opening yourself up to an easily lose-able (for you) lawsuit if you didn't counsel and document and a related bad outcome occurred. I assume counseling is standard of care

I have really strong opinions on this that are somewhat controversial. They may not be doing something to directly physically or emotionally harm their child but they are leaving them and others open to be possibly harmed, which sounds a whole lot like wanton endangerment to me. I'm no JD, but destroying herd immunity and potentially hurting someone or their old child by doing it is pretty reckless and potentially harmful. It is at best extremely arrogant and irresponsible parenting and I think those parents should be held liable if their child gets someone else really really sick. Does anyone get notified if a child's parent opts out of vaccinating it? Other than the school that is (since most require some immunizations).

I don't think I'll end up in Peds but I'm not sure how I'd react if a parent chose not to vaccinate their child no matter how I'd urge them. I'd still want them to receive medical care, but I would feel funny putting willingly unvaccinated kids in a waiting room with children that are too young or immunocompromised to receive them. That would be a little irresponsible of me.

Ah yes, you see this is what being spineless cowards as doctors gets us. It makes more problems.

These idiot mothers take their advice from Jenny "I HAVE NO MEDICAL TRAINING BUT I FEEL QUALIFIED TO TALK ABOUT THIS FOR SOME REASON" McCarthy and not trained physicians. And where were the doctors when she came out with her idiot campaign? EVERY doctor should have come out and rallied against her ignorance, but sadly this did not happen. And this is the consequence.

Of course, when SH*T GETS REAL they will come running to us and say "oh why did you not tell me to get a vaccine for my poor child?" We will say, "but we did. Repeatedly. And then some more." And then they will sue us.

nm

The site where I did my Family Medicine rotation allowed this. It was in an uber rich area that also catered to a small clientele of undocumented workers. Consequently, you had undereducated college graduates & hipster "granola" moms who did not vaccinate or selectively vaccinated their children mixing in the waiting rooms with children & adults who never received a single vaccine their entire lives in their home country. I was told explicitly (maybe even chastised ) by the attending not to question the granola moms choices or to attempt to discuss with them the adverse outcomes of non-vaccination.

Originally Posted by Rothbard

A CPS issue? Really? I know vaccination is a big deal on these forums, but come on.

Obesity is a much bigger problem (by several orders of magnitude) - I doubt you would be ok with CPS removing an obese child from it's family.
.

Yes and no. Vaccination is a problem with the potential to turn into a much, much worse problem once the number of unvaccinated children reaches a critical level. If we really have, for example, a measles epidemic in this nation it has the potential to kill or permanently disable thousands of children. Its only a minor problem for as long as we can maintain herd immunity.

Originally Posted by Rothbard

A CPS issue? Really? I know vaccination is a big deal on these forums, but come on.

Obesity is a much bigger problem (by several orders of magnitude) - I doubt you would be ok with CPS removing an obese child from it's family.

I think the real reason MD's and med students get so riled up about anti-vaxxers is that these people reject our authoritah. It's a relatively small problem compared to other **** out there. I don't know too many doctors whose "blood pressure skyrockets" when they see an obese child.

I usually see people who think vaccines cause their kids harm as people who have VERY low IQs, or people who are not too informed about basic knowledge in general. I wouldn't insult a patient like that, but I would try hard to:

1) Not and
2) Ask them "Why do they think of this" and request them to bring several journal articles and case reports

It's like herbal medicine or going to a witch doctor. Stuff we can't physically laugh at), but have to accept a reality and have to find a way to deal with it.


Or like one poster said, fire them. Good news is, you will lose a bad parent/patient. It's analogous to firing the drug seeker. Good news is, one annoying visit.

It should be a big deal to everyone(unless you don't work with kids in your career). I don't think any doctor thinks vaccines cause autism(unless they have screws loose lmao) or that not vaccinating without telling them of the major detriments is ok.

Originally Posted by Magicjewel

I have really strong opinions on this that are somewhat controversial. They may not be doing something to directly physically or emotionally harm their child but they are leaving them and others open to be possibly harmed, which sounds a whole lot like wanton endangerment to me. I'm no JD, but destroying herd immunity and potentially hurting someone or their old child by doing it is pretty reckless and potentially harmful. It is at best extremely arrogant and irresponsible parenting and I think those parents should be held liable if their child gets someone else really really sick. Does anyone get notified if a child's parent opts out of vaccinating it? Other than the school that is (since most require some immunizations).

I don't think I'll end up in Peds but I'm not sure how I'd react if a parent chose not to vaccinate their child no matter how I'd urge them. I'd still want them to receive medical care, but I would feel funny putting willingly unvaccinated kids in a waiting room with children that are too young or immunocompromised to receive them. That would be a little irresponsible of me.

Agree, it is neglect in my mind. Parents should not have the capacity to make this decision. I'm waiting for the inevitable epidemic that will arise if this continues, it may be the only chance we will have of passing legislation mandating basic vaccines for incompetent children. If people don't want influenza vaccine, I can understand that to an extent given the variable success that it can have currently, but the core childhood vaccines are absolutely solid.

Hey, I live in Washington. We're already going through a whooping cough outbreak. Gee, I wonder why?

*cough*Not enough people vaccinated/up to date*cough*

Where I worked in Pediatrics the school system would mandate immunizations for enrollment. I realize the neonates, infants, and toddlers would still be at risk, but how do certain communities allow such bad behavior to gain momentum?

Seems like not being able to put your kid in school would keep most parents on task. We a had a few granola heads but they always got snagged at daycare and school entry points.

Originally Posted by mmmcdowe

Agree, it is neglect in my mind. Parents should not have the capacity to make this decision. I'm waiting for the inevitable epidemic that will arise if this continues, it may be the only chance we will have of passing legislation mandating basic vaccines for incompetent children. If people don't want influenza vaccine, I can understand that to an extent given the variable success that it can have currently, but the core childhood vaccines are absolutely solid.

I am a big pro-vaccine kind of person and am actively involved in vaccine education programs. However, I think we need to be careful about vaccine related national laws as proposed in this editorial and that you seem to support.

http://articles.baltimoresun.com/201...nated-children

There are literally millions of children in the US whose parents have decided to not follow the standard policy. Most of these are "delayed" vaccinators who have opted not to follow the standard schedule but provide some or all of the routine vaccine. Others give no vaccines to their children at all. Even the "delayed" vaccinators are setting up their children and community for health problems.

Now, currently, every state in the US has laws related to this. Almost all (48 at last count, but not sure if that is accurate) have vaccine exemption for religious reasons. Fewer for philosophical reasons, but the line is a bit blurry here I think and a considerable delay in vaccinations might not be captured by most of these laws as a violation.

If we mandated on-time vaccines in all 50 states by federal law (something that wouldn't happen, but could be discussed here), then we would have a very large number of families whom we would have to, in some way, force to vaccinate their children. This could even include legal custody action, police action, etc. Folks who believe that vaccinations are wrong are not going to give up easily. Sure, you could keep them from public schools, but, as you are aware, that isn't going to capture a lot of them.

Is this really what you want in our country? Is the problem so great that we should legally take action against parents who wish to delay or avoid some or all vaccines? I think this is not what we want as it would be counterproductive, harmful to our society and might lead to more vaccine refusals, not less. Even ignoring slippery slope arguments of what we might do next on the mandatory parenting front, we are much better as a society and as pediatricians in working on the education front (see www.vaxnation.org for example) rather than the legal front in this.

Pediatricians, even those who are willing to work with parents on this, almost always do indicate that they support vaccinations. What the OP is referring to are a number of pediatricians who have chosen not to confront families on this issue, but work with them. Obviously, how they do this may vary and certainly some may not even bring up the issue at each visit if the family has made their view known previously. YMMV on this and I think each pediatrician should develop their own approach to this, including the option of dismissal from a practice.

Originally Posted by KnuxNole

Or like one poster said, fire them. Good news is, you will lose a bad parent/patient. It's analogous to firing the drug seeker. Good news is, one annoying visit.

It should be a big deal to everyone(unless you don't work with kids in your career). I don't think any doctor thinks vaccines cause autism(unless they have screws loose lmao) or that not vaccinating without telling them of the major detriments is ok.

Eh. It's not the same as firing a drug seeker. The drug seeker is only hurting him/herself. Here the person being hurt is the kid who has no say in the matter; for their sake, it's worth making a stronger push than "one annoying visit."

Many parents will be amenable to an adjusted vaccination schedule. Obviously that's not ideal, but it's better than nothing, so that still makes taking the time with parents in these cases worth it. Others may eventually come around after repeated conversations. And even for the ones that never budge, as others have stated there is still a lot of guidance that can be given on other important issues such as obesity. Yes, the decision not to vaccinate is "wrong" on the part of the parents, but the child deserves everything else that would be standard of care, even if their parents are pains to deal with. And as OBP states, I don't think attacking this from a legal angle would be beneficial in the long-run, and would be very harmful to doctor-patient relationships--I think we want to be seen as working with parents to educate them, not threatening them if they don't follow our orders.

Personally, I don't think I'd fire a patient over it for the reasons stated above (this of course coming while I'm still bright-eyed and full of idealism as a student), but agree that it should be one option a pediatrician has. But if one is going to go down the firing route it really shouldn't be "one annoying visit." IIRC, the AMA recommends that you give the patient written notice with a period of time during which you will continue to provide care until they can find a new physician--lest you open yourself to a patient abandonment claim.

As a negative externality, not vaccinating has a simple economic response: fine those parents who refuse to vaccinate their children. This forces them to take into account the negative consequences of their actions, including decreased heard immunity, that affect others. At the same time, it would not force people to vaccinate their children.

Regarding the patient firing issue, one point that has not been brought up is that you could end up endangering your other patients by not removing them. For example, the child is not vaccinated for X, contracts X, and brings it to the office, thereby exposing other children.

Originally Posted by sibitrum

As a negative externality, not vaccinating has a simple economic response: fine those parents who refuse to vaccinate their children. This forces them to take into account the negative consequences of their actions, including decreased heard immunity, that affect others. At the same time, it would not force people to vaccinate their children.

Regarding the patient firing issue, one point that has not been brought up is that you could end up endangering your other patients by not removing them. For example, the child is not vaccinated for X, contracts X, and brings it to the office, thereby exposing other children.

I agree completely. Pediatric clinics with all of their group play things in lobbies are cess pools--grand central stations of disease transmission. Unvaccinated kids coming in when their sick to clinic is a serious threat to your panel. Especially for younger babies who rely on herd immunity for protection being too young for some of the vaccines.

I'd fire the granola heads despite the ethics of not being able to see the kids. For the benefit of the other kids. This is the reason I've bumped pediatrics down to a distant 4th on my specialty interest list--having to work through too many knuckleheads to treat the innocent.

About a month ago, CDC released a study that looked at vaccine storage in clinics and the results weren't good. Here's a sample news article:
http://www.ktvb.com/news/health/Stud...158456265.html

We talk about the mandatory nature of vaccines and "firing" or possibly fining parents/patients/knuckleheads who don't comply, or even requiring child services or police action as OldBear cautioned us against.

What type of action should be taken against those who fail to handle/maintain vaccines appropriately? If those vaccines 'go bad' or lose effectiveness, aren't those people putting the community at the same risk as those who don't vaccinate at all? Or perhaps it's even worse because now these patients believe they are immunized against a particular disease yet don't really have that protection, or as a community we all believe that herd immunity is protecting us when perhaps it isn't.

If we are going to come down hard on parents/patients who refuse vaccinations, shouldn't we come down at least as hard on those who fail to be adequately responsible when maintaining the integrity of those very vaccines in the first place?

Originally Posted by facetguy

About a month ago, CDC released a study that looked at vaccine storage in clinics and the results weren't good. Here's a sample news article:
http://www.ktvb.com/news/health/Stud...158456265.html

We talk about the mandatory nature of vaccines and "firing" or possibly fining parents/patients/knuckleheads who don't comply, or even requiring child services or police action as OldBear cautioned us against.

What type of action should be taken against those who fail to handle/maintain vaccines appropriately? If those vaccines 'go bad' or lose effectiveness, aren't those people putting the community at the same risk as those who don't vaccinate at all? Or perhaps it's even worse because now these patients believe they are immunized against a particular disease yet don't really have that protection, or as a community we all believe that herd immunity is protecting us when perhaps it isn't.

If we are going to come down hard on parents/patients who refuse vaccinations, shouldn't we come down at least as hard on those who fail to be adequately responsible when maintaining the integrity of those very vaccines in the first place?

That...is truly an excellent point. I have intimate knowledge of flu season vaccine storage fiasco at a massive HMO that our patient population was never notified of. And for which my supervisor was nearly railroaded for trying to document and report. So yeah...we're no saints, clearly.

Originally Posted by Abider

That...is truly an excellent point. I have intimate knowledge of flu season vaccine storage fiasco at a massive HMO that our patient population was never notified of. And for which my supervisor was nearly railroaded for trying to document and report. So yeah...we're no saints, clearly.

At least it was only flu vaccine, which doesn't work very well if at all. But CDC's findings that this is happening with other more important vaccines should be more alarming.

The adjusted schedule is always a good option to go to. Quite a few parents are actually just objecting to the number of vaccines given at once rather than all vaccines in general. It also gives you a good opening for making it seem like you "understand" their concern about vaccines. Of course we all know that many of these diseases are most dangerous the younger a child is which is also a good point to bring up but getting vaccinated sometime is better than not at all.