whaddya think?

[michigangirl]

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I believe pediatricians have a total right to refuse to take care of unvaccinated kids.

http://www.studentdoctor.net/2011/10/some-doctors-refuse-to-treat-kids-who-have-not-been-immunized/

Thoughts?

 

[silverlining1]

I believe pediatricians have a total right to refuse to take care of unvaccinated kids.

http://www.studentdoctor.net/2011/10/some-doctors-refuse-to-treat-kids-who-have-not-been-immunized/

Thoughts?

In general, I do agree. However, there are 2 issues that would worry me. 1) If every practice decided to do this, where would those unvaccinated kids go to get care? They certainly still deserve care. I imagine this possibility is extremely slim. 2) What about kids with special disorders who cannot receive some or all vaccines safely? For example, at the academic hospital where I'm training, there's one pediatrician who is the go-to guy for special needs kids and those with zebra-type disorders. If he refused to treat unvaccinated kids, where would his special patients go?

 

[oldbearprofessor]

I believe pediatricians have a total right to refuse to take care of unvaccinated kids.

http://www.studentdoctor.net/2011/10/some-doctors-refuse-to-treat-kids-who-have-not-been-immunized/

Thoughts?

I think there are few people who would deny pediatricians that RIGHT, except in an emergency setting. The issue is whether they SHOULD do this. I fully support the AAP position that is articulated well in the article that this is not the best approach for pediatricians to take. However, I certainly wouldn't try to force a pediatrician to provide non-emergent care for anyone.

 

[Stitch]

I believe pediatricians have a total right to refuse to take care of unvaccinated kids.

http://www.studentdoctor.net/2011/10/some-doctors-refuse-to-treat-kids-who-have-not-been-immunized/

Thoughts?

There are many reasons I can't do general peds, but the antivax idiots are a big one. I can see plenty of reasons why a pediatrician wouldn't want to take care of unvaccinated kids, many outlined in the article. Especially when you have a waiting room full of responsible parents and vulnerable children.

But fundamentally if you disagree with vaccines, we're not going to agree on much, so why come to me? And I'm not convinced of the idea that you can win these parents over. Most believe what they believe and pestering them at every visit, aside from being tiresome, probably won't further your relationship.

Yes, I'll take care of these kids in the unit, when they are sick with preventable diseases but I wouldn't want them in my office. And as a parent I don't want their kids around mine in the waiting room.

 

[BigRedBeta]

I've had a couple of situations, even as a resident, where I've "fired" patients...I use that term extremely loosely because what really happened both times was I made the parents so mad that they didn't want to come back - but that's what happens when the very first thing you tell me when I walk in the door is that the MMR vaccine was responsible for your autistic child...

I'm with Stitch. If a child comes into the unit, I'm not going to bat an eye about vaccine status - it's just not a priority at that point. But in my continuity clinic, I frame my interaction with parents as "we're a team that's going to watch your child develop and grow as healthy as possible" and with that, I'm putting the needs of the child at the forefront and letting that guide my decisions. If a parent refuses vaccination then I find that completely at odds with that paradigm.

I know it would violate HIPAA, but sometimes I wish I could just take parents on a tour of the PICU when the kid with pertussis shows up and has to go on the vent for a week, or show the asthmatic who got influenza and ended up on ECMO.

 

[Stitch]

I know it would violate HIPAA, but sometimes I wish I could just take parents on a tour of the PICU when the kid with pertussis shows up and has to go on the vent for a week, or show the asthmatic who got influenza and ended up on ECMO.

I'm not sure even this would help. There are a lot of people who view the 'risk' of the vaccine to be far greater than the risk of ending up on ECMO or in the unit. They quote the 1/200 'risk' of autism. 🙄
Plus there's an increasing belief that 'natural' immunity (getting sick) is far better than any vaccine. So if they're kid does become critically ill, it's still better than getting the shot.

 

[oldbearprofessor]

What would those of you who don't agree to have such a family in your practice do if a parent agreed with vaccinations but insisted on delaying them or omitting Hep B and HPV? For example, if they agreed to MMR at 3 years of age. I believe this parental stand is more common than absolute refusal of all vaccines. Even if not, it is very common and a different situation than absolute refusal of all vaccines.

 

[michigangirl]

Just to clarify-- I was in no way saying that I would refuse to take care of a patient in the PICU who was not vaccinated. That would just be wrong. I only meant the general pediatrician and the routine pediatrician-patient anticipatory guidance, non-emergent relationship. Of course if there are patient's who cant' get vaccines for health reasons, etc, all bets are off. I hope that was obvious.

To rephrase-- I wouldn't fault a general pediatrician for not accepting patients/families who are anti-vaccine only because they think vaccines will cause a., b., or c. -- as long as they've had the discussion with them and tried to educate them first, but to no avail.

 

[MiniNMD]

I went from an East Coast med school to a West Coast residency program. I am constantly arguing with folks in my clinic about vaccine refusal and have seen multiple cases of pertussis sitting in the same waiting room as the kids of parents who refuse vaccines. Gee - I wonder how we got a pertussis outbreak?

The other thing that really drives me nuts though is that we have parents refusing vitamin K and erythromycin in the newborn nursery too. I didn't even think that was legal! But we let it happen - with lots of waivers of course that parents have to sign.

We also have a really good newborn screening program that gets refused all the time too. Oof.

 

[BigRedBeta]

Plus there's an increasing belief that 'natural' immunity (getting sick) is far better than any vaccine. So if they're kid does become critically ill, it's still better than getting the shot.

That natural immunity is important with a dead child...

 

[McGillGrad]

I went from an East Coast med school to a West Coast residency program. I am constantly arguing with folks in my clinic about vaccine refusal and have seen multiple cases of pertussis sitting in the same waiting room as the kids of parents who refuse vaccines. Gee - I wonder how we got a pertussis outbreak?

The other thing that really drives me nuts though is that we have parents refusing vitamin K and erythromycin in the newborn nursery too. I didn't even think that was legal! But we let it happen - with lots of waivers of course that parents have to sign.

We also have a really good newborn screening program that gets refused all the time too. Oof.

Not much we can do in continuity clinics during residency besides explaining our logic. It is frustrating, but becoming more common as Dr. Google is consulted more often.

I am extremely careful to have parents sign a mound of paperwork with every possible complication/consequence of their decision and I have witnesses sign too.

These types of parents will read every word before they sign, so at least I get another chance to indirectly influence them before they refuse vaccines/treatments.