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More Doctors 'Fire' Vaccine Refusers

Pediatricians fed up with parents who refuse to vaccinate their children out of concern it can cause autism or other problems increasingly are "firing" such families from their practices, raising questions about a doctor's responsibility to these patients.

Medical associations don't recommend such patient bans, but the practice appears to be growing, according to vaccine researchers.

By comparison, in 2001 and 2006 about 6% of physicians said they "routinely" stopped working with families due to parents' continued vaccine refusal and 16% "sometimes" dismissed them, according to surveys conducted then by the American Academy of Pediatrics.In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.

Most pediatricians consider preventing disease through vaccines a primary goal of their job. The Centers for Disease Control and Prevention and AAP issue an annual recommended vaccination schedule, but some parents ask if their child's immunizations can be pushed back or skipped altogether, pediatricians say."There's more noise among pediatricians, more people willing to argue that it's OK to do this versus 10 years ago," said Douglas Diekema, a professor of pediatrics at the University of Washington in Seattle. Dr. Diekema wrote the AAP's policy on working with vaccine refusers, which recommends providers address the issue at repeated visits, but respect parents' wishes unless it puts a child at risk of significant harm.

Parents often voice concerns about autism or that their child's immune system may be overwhelmed by too many vaccines at once. Worries about a link between vaccines and autism arose because some parents noticed their children regressed, or lost some skills, around the time of their vaccinations at two years of age. Another concern centered on the former use of mercury as a vaccine preservative.While rates for several key inoculations in young children rose between 2009 and 2010, according to the CDC, lower immunization rates have been blamed as a factor in U.S. outbreaks of whooping cough and measles in recent years.

Numerous studies since have dispelled these concerns among scientists. Rather, scientists say, it is more likely that autism symptoms begin showing up around the same age children are vaccinated.

The rise in patient firings reflects another factor. As patients have become savvier and more willing to challenge doctors, physicians have become increasingly reluctant to deal with uncooperative patients, said Arthur Caplan, a bioethics professor at the University of Pennsylvania. In addition, doctors may feel financial pressure to see more patients and so have less time to contend with recalcitrant ones.

For Allan LaReau of Kalamazoo, Mich., and his 11 colleagues at Bronson Rambling Road Pediatrics, who chose in 2010 to stop working with vaccine-refusing families, a major factor was the concern that unimmunized children could pose a danger in the waiting room to infants or sick children who haven't yet been fully vaccinated.

In one case, an unvaccinated child came in with a high fever and Dr. LaReau feared the patient might have meningitis, a contagious, potentially deadly infection of the brain and spinal cord for which a vaccine commonly is given. "I lost a lot more sleep than I usually do" worrying about the situation, he said.

"You feel badly about losing a nice family from the practice," added Dr. LaReau, but families who refused to vaccinate their kids were told that "this is going to be a difficult relationship without this core part of pediatrics." Some families chose to go elsewhere while others agreed to have their kids inoculated.

Pediatricians disagree about what their duty is to these families. "The bottom line is you should try to do whatever you can to maintain the family in the best care," said Michael Brady, chair of the pediatrics department at Nationwide Children's Hospital in Columbus, Ohio, and a member of the AAP's immunization committee. "If they leave your practice, they're probably going to gravitate toward another practice with unhealthy practices."

Other physicians say they rarely have had luck persuading vaccine opponents to change their minds.

David Fenner and his 20-plus colleagues at Children's Medical Group in Rhinebeck, N.Y., discuss vaccine concerns but ask families to leave if they don't comply by a certain point.

Dr. Fenner said he tells new families, "You've been bombarded with information before you came here, some accurate and some not." Iif a family refuses to vaccinate after a discussion of the issue, he tells them "there are so many things we're not going to see eye-to-eye on."

So far, the practice has fired a couple of families per year since it implemented the policy about five years ago.

Pamela Felice, who lives in an Atlanta suburb, had difficulty finding a pediatrician for her two children though they have waivers from a previous pediatrician exempting them from school requirements for immunizations. Her older child had gastrointestinal trouble and regressed development after receiving vaccines, she said, which she believes were related to the shots.

Ms. Felice received a letter from her pediatrician a few years ago stating that because the family chose not to vaccinate, it needed to find another doctor. She called four or five other practices but none would agree to an appointment after she told them she was opposed to vaccines. The family ended up with an elderly family doctor who said he had "seen it all" and was willing to treat the children if they got sick, Ms. Felice said.

"A doctor should feel obligated to discuss [potential vaccine] risks with any parent who wants to discuss them," said Ms. Felice.

Write to Shirley S. Wang at shirley.wang@wsj.com

Date: 2012-02-16 12:14 am (UTC)
From: [identity profile] a-tergo-lupi.livejournal.com
I feel safer going to a doctor's office if I know I'm not at risk from diseases that shouldn't be around anymore. I'm glad my doctor knows that.

Date: 2012-02-16 12:46 am (UTC)
From: [identity profile] breakableheart.livejournal.com
Can't read any further - stuck on "you feel badly".

You feel badly? Like the mechanism through which you feel is not working correctly or something?

I'm glad my health care provider works with me. My health care (and my child's health care) are, ultimately, my choice. I would hate to have a health care provider who steamrolled me. I get to have input and understanding of the health care provided for me.

Date: 2012-02-16 12:49 am (UTC)
From: [identity profile] breakableheart.livejournal.com
Also FUCK OFFFFFFFFF with all the "wank wank bleat bleat autism isn't caused by vaccinationssssssss" crap.

NO ONE I know who has delayed or eschewed vaccinations for any reason (including me) have done so out of fear for autism. NO ONE! I think those five people? They're living in shacks out in the woods in the unpopulated areas of Wyoming so we don't have anything to fear from catching disease OR autism from them. NO ONE BELIEVES VACCINATIONS CAUSE AUTISM! It's an old tired trope wankers hold onto because they can't understand anything else. Bwak bwak bwak! Buncha hens.

Date: 2012-02-16 01:23 am (UTC)
From: [identity profile] gryphonwing.livejournal.com
Five different people have told me they're not vaccinating their kids because vaccines cause autism.

So I take your anecdote and add my anecdote. I think they cancel each other out.

Date: 2012-02-16 01:24 am (UTC)
From: [identity profile] breakableheart.livejournal.com
Move away from Wyoming. Out here in the real world there is electricity and indoor toilets!

Date: 2012-02-16 03:32 am (UTC)
From: [identity profile] feckalyn.livejournal.com
Amy, I've heard patients say they don't want vaccines out of fear of autism (this fucking week). And for fear of thimerosol. And for fear that the government is trying to poison their kids. And for fear that there are too many shots at once. And for fear that their baby will cry. And for fear that Santa Claus will assrape them if Antigua is on fire tomorrow. I am on the front line here and know of what I speak; have been on off and on for almost 14 years. So if posting this means I'm a wanker, so be it!

I live in a major metropolitan area (lets not spend too much time on WHERE this city is located as we all know how I feel about the Midwest). There is still a great deal of misinformed fear floating around out there. And unfortunately it is ignorant comments like these that can foster further ignorance among those who don't know better. I know YOU know why you're choosing to vaccinate your child how you are but not everyone is as educated as you (and the rest of boojoonooojuuu).

I'm not going to argue with you on this one (and I'm sorry if I sound pedantic, not my intent). I posted this because it was interesting to me and because I am very pro-vaccine.

Date: 2012-02-17 05:13 am (UTC)
From: [identity profile] -evalution.livejournal.com
thank you.

this article just made me glad i live in hippy dippy oregon where my kids' ped doesn't blink an eye if i refuse or delay vaccines.

Date: 2012-02-17 12:31 pm (UTC)
From: [identity profile] feckalyn.livejournal.com
I hope you know it is never my intent to make anyone feel stupid by posting these types of posts. This is a highly emotional and contentious issue and I happen to have a very strong opinion that is different from your very strong opinion. I am not trying to make anyone feel or look bad(ly).

Date: 2012-02-16 01:26 am (UTC)
From: [identity profile] gryphonwing.livejournal.com
I'm mildly ambivalent, but only mildly. If parents don't want to vaccinate their kids, whatever, but that doesn't mean they get to bring those kids into areas extremely likely to have other children who are pre-vaccination age.

If I were a doctor, that would be my primary concern. You don't get to choose what risks other people's children take.

My solution would probably be to block out times for only unvaccinated children, but even that wouldn't make it safe, not really.

Date: 2012-02-16 03:37 am (UTC)
From: [identity profile] feckalyn.livejournal.com
That's essentially my position actually.

My practice would NEVER (ever ever ever ever) fire a family for something like this (we have WAY bigger fish to fry with the schizophrenic, HIV+ folks who are off their meds and threatening us with sharpened popsicle sticks). I was unaware that such high numbers of pediatricians were turning non-vax families away entirely and was fascinated.

Date: 2012-02-16 02:25 am (UTC)
From: [identity profile] girlomega.livejournal.com
Just as I am allowed to tell a doctor I don't want to see them anymore and will be finding a new GP, the doctors can tell me they don't want me as a patient anymore.


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