For those who vaccinate - a question

leomom

Mon, Dec 05 2011, 12:18 pm

nylon wrote:

yy wrote:

Your doctor sounds terrific and you're lucky! But when they say they'll "discuss" vaccines with you, what happens when in that discussion you tell them that you've read the sheets and you prefer not to have your child vaccinated?

Then they ask you to find a new practice. It says so right in the letter they give you and they'll tell you the same thing if you call and ask. No secrets. Like I said, they had too many problems with patients wanting alternative schedules; this is a new policy they implemented earlier this year. Another large peds practice did it last year and a 3rd has followed suit. Rumor has it that insurance is dinging providers with poor compliance.

In other words, as more and more practices implement policies like this, it will become harder and harder to selectively vaccinate, even if it's allowed in theory. It's pure coercion. I don't like the direction this is heading at all.

Orchid

Mon, Dec 05 2011, 10:03 pm

Kicking patients out due to varying vaccine opinions/requests is actually against AAP guidelines. As my wonderfully open minded pediatrician says, "vaccinating is 5% of what I do." Children need well and sick care regardless of whatever their vaccine status, and it's counter-intuitive to deny them that care. Unless, of course, the doctor is doing it as a coercion tactic, in which case it makes perfect sense.

tikva18

Mon, Dec 05 2011, 10:24 pm

Orchid wrote:

Thank you for posting this. I have friends who've been kicked out of practice after practice due to this. I keep telling them to come to our ped - lol. She's understanding and has been willing to work with me while I grapple with this. My kids are all vaccinated except for my twins - who are missing 2. I'm waiting until they are a little older when I'll re-evaluate.
And I know I've come across strongly in this thread, but I think that there is cause for concern (hence why I've delayed vaxing them).

Here's the link to the AAP where they discuss this: http://aappolicy.aappublicatio...../1428
"What is the pediatrician to do when faced with a parent who refuses immunization for his or her child? First and most important, the pediatrician should listen carefully and respectfully to the parent's concerns, recognizing that some parents may not use the same decision criteria as the physician and may weigh evidence very differently than the physician does.21 Vaccines are very safe, but they are not risk free; nor are they 100% effective.22 This poses a dilemma for many parents and should not be minimized. The pediatrician should share honestly what is and is not known about the risks and benefits of the vaccine in question, attempt to understand the parent's concerns about immunization, and attempt to correct any misperceptions and misinformation.23–25 Pediatricians should also assist parents in understanding that the risks of any vaccine should not be considered in isolation but in comparison to the risks of remaining unimmunized. For example, although the risk of encephalopathy related to the measles vaccine is 1 in 1 million, the risk of encephalopathy from measles illness is 1000 times greater.22 Parents can also be referred to one of several reputable and data-based Web sites for additional information on specific immunizations and the diseases they prevent (see pages 52 and 53 of the Red Book25 for a list of Internet resources related to immunization).

Many parents have concerns related to 1 or 2 specific vaccines. A useful strategy in working with families who refuse immunization is to discuss each vaccine separately. The benefits and risks of vaccines differ, and a parent who is reluctant to accept the administration of 1 vaccine may be willing to allow others.

Parents also may have concerns about administering multiple vaccines to a child in a single visit. In some cases, taking steps to reduce the pain of injection, such as those suggested in the Red Book,26 may be sufficient. In other cases, a parent may be willing to permit a schedule of immunization that does not require multiple injections at a single visit.

Physicians should also explore the possibility that cost is a reason for refusing immunization. For a parent whose child does not have adequate preventive care insurance coverage, even the administrative costs and copayments associated with immunization can pose substantial barriers. In such cases, the physician should work with the family to help them obtain appropriate immunizations for the child.

For all cases in which parents refuse vaccine administration, pediatricians should take advantage of their ongoing relationship with the family and revisit the immunization discussion on each subsequent visit. As respect, communication, and information build over time in a professional relationship, parents may be willing to reconsider previous vaccine refusals.

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. Physician concerns about liability should be addressed by good documentation of the discussion of the benefits of immunization and the risks associated with remaining unimmunized. Physicians also may wish to consider having the parents sign a refusal waiver (a sample refusal-to-immunize waiver can be found at www.cispimmunize.org/pro/pdf/R.....m.pdf). 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.27 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."

leomom

Mon, Dec 05 2011, 10:39 pm

Thank you so much for posting that! It's very sensible and respectful. If that's the AAP's official stance, I wonder how so many practices can have policies that seem to disregard it?

tikva18

Mon, Dec 05 2011, 10:50 pm

yy wrote:

Thank you so much for posting that! It's very sensible and respectful. If that's the AAP's official stance, I wonder how so many practices can have policies that seem to disregard it?

I think because the AAP does not force compliance among their practioners (irony much? - lol).

nylon

Tue, Dec 06 2011, 11:02 am

The problem with the AAP policy is that it does not address the real concerns of pediatricians who adopt this policy:

1) getting dinged by insurers for low compliance
2) the additional time and therefore cost of spread out vaccine schedules, and risk of lower compliance (the CDC/AAP schedule is designed to maximize compliance)
3) Liability. Measles was spread in a doctor's waiting room: http://www.cdc.gov/mmwr/previe.....3.htm
BTW, I've been told (reliably) that the practice in question was Dr. Sears. Ah here: http://healthyliving.ocregiste.....1974/

Not to mention, in practice, non-vaccinating parents don't really like the AAP's strategy of "try to talk them into it, and keep bringing it up if they refuse." They say it more nicely, but that's what they mean.

tikva18

Tue, Dec 06 2011, 12:05 pm

nylon wrote:

When my brother had the measles I called the dr.'s office beforehand to let them know that I thought this is what he had. They said to bring him straight in. I asked if I could take him into a side door - and they refused to believe that it could be measles - why shouldn't I bring him into the waiting room? I insisted on a side door - they were reluctant to diagnosis it at all - since it would mess with their perfect numbers.

Back story is there was an epidemic at one of the university campuses and everyone age 18+ had to get boosters, but my brother was only 17 and came down with it. I had had my booster.

leomom

Tue, Dec 06 2011, 12:59 pm

nylon wrote:

Personally, I find it a small concession to just allow my pediatrician to do her routine vaccination discussion at each visit (the discussion gets shorter each time - and ends up being just, "So you're not vaccinating, right?") to satisfy their need to protect against liability. I also sign waivers.