No Vaccine, No Patient Care

In recent years, the anti-vaccine movement has increased in the United States. Despite the medical community’s overwhelming pro-vaccine stance, a small, but vocal group of parents have used sensational stories, questionable studies, and fervent beliefs to convince themselves and others from vaccinating their children. As a result, physicians today are often faced with a difficult decision: Do they continue to care for unvaccinated patients, and put other patients at risk, or do they choose to dismiss these patients?

Earlier this a month, a new study appearing in Pediatrics aimed to answer the question of how doctors are handling the decision. The study surveyed 534 pediatricians and family physicians from June to October 2012. Overall, the majority of respondents (83 percent) reported that they have at least 1 percent of families refuse vaccines in a typical month. The survey also found that one in five pediatricians said they “often or always” dismissed these families.

Although, 20 percent of the pediatricians said they would dismiss patients who are not vaccinated, the results varied based on location and practice ownership. For instance, in states that do not allow philosophical exemptions to vaccines, the proportion of physicians who reported they dismissed patients was four times higher than in states where philosophical exemptions were allowed. Only 9 percent of pediatricians reported they dismissed patients in the states where philosophical exemptions are allowed. Additionally, pediatricians in private practices were five times more likely to dismiss families who refused vaccines.

From the survey, it’s clear that government and organization policy plays a large role in how physicians choose to handle the decision on vaccinations, but what the results neglect to show is how difficult the choice actually is. Vaccine expert and chief of the division of infectious diseases at Children’s Hospital of Philadelphia, Dr. Paul Offit, acknowledged how pediatricians are in a “tough spot.” They follow an oath to care for every patient, but they also have to look out for the collective good of all their patients. By caring for unvaccinated children, particularly in areas where herd immunity levels are low, they put other patients in danger. Their pediatric waiting room, full of newborns and patients unable to receive vaccines for health reasons, essentially becomes a danger zone. Many providers also feel that if they accept unvaccinated patients, they are sending a weak message about the importance of vaccines.

Whether a pediatrician chooses to continue to treat an unvaccinated patient or not, communication is essential to the equation. First, physicians must effectively communicate the value of vaccines to make a strong recommendation. By listening, establishing trust and being assertive, physicians are more likely to dispel any fears and convince families to vaccinate. If families still choose not to vaccinate, physicians must communicate in a clear manner their policy on how they handle unvaccinated patients. If they choose to dismiss the patient, the policy should be cited and the specific reason and rationale for their dismissal articulated. And, if physicians continue to treat unvaccinated patients, protocols should be established and communicated on how families should seek care if their child presents with symptoms from vaccine-preventable diseases, including whopping cough and measles. 

The answer of how to handle treating unvaccinated patients is certainly not an easy one. In the end, it comes down to the discretion of the individual physician and their colleagues, but regardless of the decision, effective communication is a critical component. Ultimately, providers should advocate for the important role of vaccines in healthcare and make their position known to patients.