Is it OK for doctors to refuse to take care of people who refuse vaccines?
Last week, the journal Pediatrics published a study describing the characteristics of physicians who dismiss families for refusing vaccines. Perhaps most shocking was the finding that 83% of the over 500 physicians surveyed reported that in a typical month, at least 1% of parents in their practice refused at least 1 infant vaccine. Many personal stories from doctors followed in the news, and as I read them, my first thought was – how terrible. How could a doctor refuse to care for a whole group of patients? Especially vulnerable children, who had no say in the decision. It goes against everything we’ve been taught.
But then I read on.
One of these doctors instituted the policy of refusing to care for unvaccinated families after an unvaccinated child showed up in his waiting room with whooping cough, exposing several infants and another child with leukemia to this potentially fatal and preventable illness.
It hit a chord. As the mom of 3 young boys, someone is always sick in my household. We’re cautious, but not over-the-top about germs. I know kids get sick, and I know they can fight colds with strong immune systems, and that it’s not the end of the world. I’ve had the flu, I even had chicken pox, and I lived to tell.
But whooping cough, influenza, chicken pox, measles, and many other vaccine-preventable infections aren’t “just colds.” They are serious infections that can kill people. And just because one of these didn’t cause a debilitating illness in me or you, it doesn’t mean that if or when we get them we can’t pass them on to someone who doesn’t have the immune strength to fight them. You may have already read about why I chose to get a flu shot this year – to protect my son, my grandmother, and my good friend, all of whom could die from the infection that in me might only feel like a no-big-deal-kinda-cold.
The recent study in Pediatrics showed that in the states where doctors were less likely to dismiss patients for refusing vaccines, there were lower vaccination rates and higher rates of vaccine-preventable diseases. So while my gut reaction was at first that these doctors were betraying their patients by dismissing them, I then thought about all of the other vulnerable children in their practices that they were protecting. And I thought about the Hippocratic oath we all took in medical school – where we vowed to “take care that [our patients] suffer no hurt or damage.” And things got a lot less obvious.
As an adult gastroenterologist, I don’t have a ton of conversations about vaccinating children, but every day I talk to people about illnesses and various ways of treating them. And my stance has never been to be someone who paternalistically dictates a treatment plan to a patient. My patients are adults, my peers, and I respect their intelligence. I think it’s overstepping my boundaries to be telling them what to do. Instead, I see it as my job to provide them with all the info they need, so that they can make educated decisions for themselves. Except in really unique circumstances, most of the people I see are competent adults, who have the right to make their own decisions, even ones that I don’t agree with.
For the most part, I feel that way because their health decisions are their business and don’t have much direct impact on the physical health of anyone except themselves. But what I’ve realized is that when it comes to vaccines, that’s just not true. Those decisions impact the people around them far more than they impact themselves. So I really feel for those pediatricians who face this everyday. They’re trying to “do no harm.” Aren’t they doing a ton of harm by allowing unsuspecting vulnerable children to sit in their waiting rooms with people who could realistically be carrying preventable and life-threatening infections?
So why is it that people are more and more refusing to get vaccines for themselves and their kids? The short answer is, I have no idea. I set out to write a few of the most common reasons, and explain whether they are valid or not. But as I did, I realized I sounded like Charlie Brown’s teacher (whaamp-whaamp-whaamp) – this is really, really old news, and did I really need to be belabouring these points? I can’t imagine that anyone, especially someone who had made the conscious choice to refuse the vaccines the pediatrician was recommending for their child, would not know that the study showing a link between thimerosal and autism was retracted and the author totally discredited (but if you’re curious, the top three reasons people refuse vaccines article can be found here). I think it goes deeper – an inherent mistrust of mainstream science and medicine, maybe that all of this “good information” is just part of a giant conspiracy theory, or some sort of secret arrangement between every doctor and the companies that manufacture vaccines. How can a doctor carry on a relationship with a patient or family who feels this way? Mutual trust is fundamental to a sound doctor-patient relationship.
Like I said, I’m a mom to 3 young boys, and my main concern is to keep them safe and happy. I’ve chosen to vaccinate them because I am overwhelmed with the amount of sound data supporting the benefits of vaccines. I don’t want my boys to get sick from whooping cough, measles, or mumps. I don’t want any potential future daughters-in-law to get cervical cancer. And I haven’t seen any compelling quality evidence to suggest that vaccines are bad. I’m a doctor and so are 90% of the people I know, and no one I know gets kickbacks of any sort from anyone for recommending or administering vaccines. The only juice we all drank was the one called I Practice Evidence Based Medicine. And as for the unvaccinated children sharing a pediatricians waiting room with my kids? I think it’s scary. Really scary. I’m comforted because I know my kids are most likely immune to those infections. Because I’m lucky and my kids are healthy. But that’s not the case for everyone, and if it weren’t for me, I’d be out of that waiting room in a heartbeat.
Oh, and Bellyblog’s very own media producer Dr. Seema Marwaha made this video that might help explain some of those misconceptions I talked about.