More on pediatricians “firing” families for refusing vaccines. “More surprising to the authors were two findings: 39 percent of those surveyed said they would consider turning away a family that refused all shots — researchers had expected the number to be about 20 percent — while 28 percent said they’d think about severing a relationship with a family that refused some shots.”

Consider the ramifications of this:

If this child, or any child, gets sick and dies as a result of not receiving needed vaccinations, who will the parents sue? The lawyers who launched the campaign? Or the pediatrician who didn’t browbeat them into getting the vaccination?

(via PointofLaw.com)

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  • Anonymous

    Just document your reccomendations; that’s enough. Consider a vaccine refusal form for each vaccine refused.

  • Anonymous

    Just document your reccomendations; that’s enough. Consider a vaccine refusal form for each vaccine refused.
    The problem is that the refusal carries implications for public health, not only for an individual child. As long as only one or two refuse, it doesn’t matter, but if many refuse there’ll be a risk for other people as well. I wonder if there shall be some flexibility: allow refusal (with sign form) for vaccines that would only impact the particular child, but not for those that have implications for others.

  • Anonymous

    Certainly document the discussion and the refusal. It helps to follow up the visit with a certified and receipted letter reinforcing the recommendation to vaccinate, the reference to literature or a website and a specific request for a return visit and a specific appointment. If they don’t comply with the request, that should also be documented. At that time it would be prudent to terminate the professional relationship.

    As bad as terminating doctor-patient relationships may seem, I don’t think it happens nearly often enough. It should be done calmly, professionally and as a result of well-documented non-compliance. Referral to a central hospital referal agency is sufficient. 30-days time for emergency coverage only–no appointments, though–is adequate coverage.

    CH

  • Anonymous

    While I fully support the right of physicians to “fire” their patients, I see this as more of an ethical issue.

    To me, the doctor’s role is to discuss the risks and benefits of a proposed treatment or procedure, to help me make the best decision for myself, or on behalf of my children if they are the patient. Not to strong-arm me into making a decision that is best for society at large. I want my doctor to give me his/her opinion based on what is best for my child, not an opinion that is based on what the CDC says, what the Health Department says, or the bonus that my insurance company is paying him for having a 100% immunization rate. That’s just too many parties involved in the doctor-patient relationship, in my opinion, and can lead to conflicts of interest.

    I am speaking as a parent who does not vaccinate for religious reasons, and who was “fired” by our son’s pediatrician for that reason. We now see a family practice doctor who is much more flexible. However, I will admit that we do not go in for nearly as many well-baby/child check-ups as we would if it were a non-issue.

  • Anonymous

    The last poster is a good example of a bad problem.

    One has to assume that you go to a professional to obtain advice and treatment you are not qualified to give yourself, not to simply read and consider a “menu” from which you can decide which “makes sense” according to your world view. The professional has training and experience you do not have, and has been vetted to actually have that experience. Those papers on the wall actually do represent something significant.

    Sorry to say, but it just isn’t all about you and your decision-making ability. Some adults have poor judgment, no matter what you tell them, and some make poor decisions on behalf of others when they have the chance. So there are other charges the physician has separate, apart, and independent to the obligations you think are limited to you. One is as a public health officer. We are required to report some diseases, regardless of what the patients think. We are also required to report evidence of neglect and abuse. Your particular religious persuasion, and whatever that religion propells you to say and do is not the least bit relevant in that regard. It seems to me that you regard your particular religious beliefs as having at least the same weight as professional advice. That is the beauty of being in a free country: you can believe what you want, no matter how irrational it may seem to others. Professional knowledge has to pass public scrutiny with those whose charge it is to determine standards, and there are consequences to those whose advice and practiice does not meet those standards.

    Consider yourself lucky they only fired you. If it were up to me, you would be prosecuted for child abuse by medical neglect.

  • Anonymous

    anon 7:20
    very well said!

  • Anonymous

    Hey anon 7.20, there’s a name for you: medical Stalinist. Despite all the scraps of paper on your wall and your self-vaunted “professionalism,” you obviously forgot that this country was founded by people (Pilgrims, Puritans, Mormons, Catholics) who wished to educate and bring-up their children as they–not the prevailing wisdom of the times–saw fit. (Ah–yes, if you had been alive in 1620, perhaps you would have reported parents to prosecutors who did not wish to get their children bled with leeches.) Society benefits from people who have the guts to thumb their noses at society’s prevailing intellectual consensus–after all, it’s usually wrong.

    BTW, you are not a “public health officer” in any jurisdiction I know of. The fact that statute requires you to spy on your customers is irrelevant.

    As for your professional judgment and advice—well, I suppose we all need comforting myths: some need religion, others need the vanity of their employment.

    People should feel free to stand up to professionals because professionals too often get it wrong. Medicine should be (and I think is becoming more and more with the internet and other sources of information) a business and service like any other. Customers should decide from a “menu” which services that “make sense” according their world view–just like any other transaction. It’s a free country, isn’t it?

    BTW, just make sure your jurisdiction has an immunity provision–someone might very well bring a libel action against you should you report a Christian for professing his beliefs.

  • Anonymous

    Well, Anon 3:37, you certainly seem to have your autonomy issues. Why you would even go to a professional for any kind of advice is a wonder, since you seem to hold your own opinion at least as highly as everyone else’s, informed or not.

    Medicine has often gotten things wrong. That is the great thing about medical knowledge, it isn’t fixed. All it takes is sound evidence, and things change. The same isn’t true for religious beliefs or any faith-based professions. As for what the CDC says, or the health department says, their word is only as good as the evidence supports, which while not perfect, is more rational than some religious practices. Contrary opinions are not merely functions of someone else’s “vanity”.

    Stalinist? Hardly, unless that is your blanket classification for anyone who tells you what you don’t want to hear or won’t go along with every idea that comes to your mind. Your autonomy as concerns your health or those of your children is not absolute; centuries of law have established that.

    “BTW, you are not a “public health officer” in any jurisdiction I know of.”

    For all I can see, you may have knowledge of no jurisdictions anywhere, so your statement could well be true. Please correct me if you do in fact have some expertise otherwise. Licensed practitioners are required to report certain disease findings to the department of health, as a condition of their license.
    This is an official public health responsibility.

    Your comments are shrill and ad hominem. Surely you can come up with something better.

  • Anonymous

    “BTW, just make sure your jurisdiction has an immunity provision–someone might very well bring a libel action against you should you report a Christian for professing his beliefs.”

    Who said anything about Christian beliefs, anyway?

    And where does the notion of libel apply here?

    Reporting requirements are usually specific, there isn’t much room for interpretation.

    Your last comment is outright paranoid.

  • Anonymous

    And on what planet do you practice medicine, doctor?

    “Medicine has often gotten things wrong. That is the great thing about medical knowledge, it isn’t fixed. All it takes is sound evidence, and things change.”

    HA, HA, HA! If that were true, why do we have the entire evidence-based medicine movement? The point is that much of what doctors do is done simply because they have been so trained, regardless of the evidence. That’s what the Dartmouth project has shown. http://www.dartmouthatlas.org/about.php

    This point circles back to your Stalinist need for obedience from your patients. (BTW, were you beated up by other kids in the schoolyard. . . ) Medicine as practiced today is simply not sufficiently rigorous to demand such obeisance. There’s plenty of room in the profession’s ignorance for health care customers to say “shove it”

    I’m glad, in general, for people like anon 6.33 who can stand up to vaunting (I’d argue criminal) pretensions of your profession.

  • Anonymous

    Oh, one last thing

    “Your comments are shrill and ad hominem. Surely you can come up with something better”

    You just told a religious family who could have been part of the many religions who refuse immunizations that they were child abusers. And, I am shrill and ad hominem because I point out your ignornance and contradictions. Indeed!

  • Anonymous

    Anon. 5:02/5:06, please calm yourself. This is a weblog response thread to a blog posting about a news article, not a consultation room. There aren’t any “families” here, only individuals posting their opinions about the subject.

    Ad hominem? Well, calling others “Stalinists” for having opinions about the impropriety of refusing immunizations for minor children based on the religious principles of the parent pretty much fits the bill. I think you are lazy for writing that. Name calling is cheap theater. Do you even know anything about Stalin? I wonder.

    As for withholding immunizations, we can now see polio again in the west, thanks to the wisdom of those whose religious convictions prohibit childhood
    immunization. Hey, what could be more important than exercising every last one of your religious beliefs, even at the expense of the health of your own children? Medicare and Medicaid will pick up the tab for that iron lung, anyway.

  • Anonymous

    Hmmm . . . so the poster who objected to the doctors is unbalanced and needs “to calm himself” Hmmm. . . can this be the medicalization of dissent? That is Stalinist. So perhaps the poster was not “lazy” but so on target that doctors had to employ a rhetoric of control.

    Look. If we as a nation want to pass laws penalizing people who don’t get vaccinated (as many states have), fine. However, if people live in states where are free to choose, doctors should not stand in the way. IT’s not their decision.

  • Anonymous

    Involuntary commitment of persons who express dissenting political views who aren’t mentally ill was a Stalin-era practice. How exactly does that apply here?

    Tarring a poster with the label “stalinist” who thinks there should be reasonable limits to expression of religious freedom, including limits to decline immunization against communicable diseases on behalf of minor children is reckless and lazy discourse. It is not “medicalization of dissent” as you slyly put it. It hardly matters what my medical qualifications are; it is a cheap shot no matter who the recipient is. And it is lazy because you are trying to defeat the argument not by making salient counter-argument, but by demonizing the poster. So much easier not to have to listen to what that vain Stalinist doctor has to say, isn’t it?

  • Anonymous

    While I fully support the right of patients to refuse tests/treatment for myself, as long as people live together there will always be a line when the health of others is concerned.
    A pregnant woman going to a doctor’s office doesn’t want to catch German measles because another patient refused to vaccinate her child. In fact, she’d probably held the doctor liable for exposing her to it. Vaccines are not 100% effective, so you need the majority of people vaccinated to protect others.

    When the Soviet Union was collapsing a lot of people refused to vaccinate their children — an since they were reusing needles, could anyone blame them? Hey, most people on this board would do the same. But a few years later they had an epidemic of diphteria. I think they still have it in some areas.
    As far as religious beliefs are concerned, what if someone whose beliefs preclude him/her from obtaining medical treatment has an active TB? Would those of you who argue for “religious freedom” in medical choices say it is OK and let this person go around and infect others?

  • Anonymous

    The lack of knowledge on this thread is astounding. Have any of you anti-vaccine guys ever taken care of the survivors of the last of the polio epidemics before the Salk/Sabin vaccine (I have). Do you have any idea how crippling this disease can be to those lucky enough to survive? Do you know what is post polio syndrome? I suggest you make the effort to seek out the survivors of the last of the polio epidemics of the 1940′s-1950′s. They are still out there. Get an idea of what polio really is and how these poor souls lives have changed on account of the disease. I am not a pediatrician but if I was, you can be sure your children would not be part of my practice thanks to your stupidity.

  • picker and chooser.

    Medicine is professional ART, and patients are hiring you for advice, not orders. While supporting a physicians right to dismiss a patient, I would expect this to be limited to situations that compromise the phsyicians practice, not the broader category of “patients who make choices against advice.” Firing a patient for refusing a few of the currently available vaccines is not good medicine, in my view.

    In 1990 I refused pertussis vaccine for my baby son, although I would no have if the acellular vaccine had been available. I think I did the right thing for *my* child, and I was absolutely content to exploit herd immunity at the time to avoid risk for my own child. I knew full well that my own choice was for factors about to be eliminated by a new vaccine, and that my choice would not add significantly to the risk of anyone, including my baby, given our lifestyle and location at the time.

    I would today reject a hepatitis B vaccine for my baby, unless specific circumstances warranted vaccine to eliminate a higher than usual probability of risk.

    My son also was not vaccinated for varicella. The vaccine was new, not mandatory, and a little controversial until the time he caught chickenpox and made the issue moot. I wish I had gotten the vaccine for him: his case was not as mild as my own, and he suffered a good deal and was left with multiple permanent pock marks as a reminder.

    Now, would you have fired me? I didn’t get fired by our pediatrician, and everthing seems to have worked out well.

  • Anonymous

    No medicine is based in science. The more people not vaccinated the more likely these diseases will find their way back in the population. Have you ever seen a case of whooping cough? Please do us all a favor and go to another blog where your idiocy is not so obvious.

  • Anonymous

    “I was absolutely content to exploit herd immunity at the time to avoid risk for my own child”

    In other words, you were gambling, except not for money.

  • Picker and Chooser

    Sure, I’ve seen whooping cough – I’ve HAD whooping cough, though as a young adult, not a baby. And I had been vaccinated myself as a child.

    The vaccine available in 1990 was not the acellular version available today.

    When I brought my son in for boosters prior to entry into kindergarten, my own pediatrician recommended against vaccination for pertussis even with the acellular version. He felt there was no compelling reason to give the vaccine at this point, though I was perfectly willing.

    Our families risk of exposure to whooping cough was low when my son was an infant…for many reasons, but I was also relying on the high rate of vaccination of the local folks. Most parents did not know at the time that it was even possible to get a DT shot instead of DPT.

    I would not refuse that vaccine today, since the advent of acellular pertussis vaccine. However, would you fire a patient for refusing a Hepatitis B or varicella vaccine?

  • Picker and Chooser

    “you were gambling, except not for money”

    Yes, I did a risk assessment and came down on the side of not risking injury from the old pertussis vaccine, after determining the risk of pertussis infection was in-fact, very low for my baby. I discussed it with the pediatrician at the time. Looking back in hindsight, he may have been afraid to insist on the old vaccine, with acellular vaccine just around the corner – afraid of what I would do if he talked me into it and my son had a serious reaction.

    He’s fifteen now, and it’s a non-issue.

  • Anonymous

    “Yes, I did a risk assessment…”

    Well I am sure it must be a competent “risk assessment” since you know how to google. Forget the national guidlines by the experts in the field complete dispute your “assessment”. Please go back to the nutball blogs.

  • Anonymous

    You know, I never wear seatbelts, because they can trap you inside a burning car and you will get burned to death.

    This is EXACTLY the kind of stupid logic the anti-vaxxers use. They cite all the vaccine side effects.

    With zero vaccinations, you’ve got the following lifetime risks of catching the disease:

    Pertussis: 1 in 5000
    Diptheria: 1 in 3000
    Tetanus: 1 in 8000
    Polio: 1 in 5000
    Measles: 1 in 12,000
    Mumps: 1 in 20,000
    Rubella: 1 in 50,000

    Now, here are the risks of serious side effects from the vaccines:

    DPT: 1 in 400,000
    Polio (Salk): 1 in 1 million
    MMR: 1 in 800,000

    In case you are logic-impaired, that means you are an absolute fool for refusing the vaccines. You are guilty of the “I’m not wearing my seatbelt cause its dangerous” idiocy.

    Please educate yourself and quit putting your innocent kids at risk for terrible disease. Maybe you should go read about the iron lung that polio victims had to suffer through.

  • Picker and chooser

    Anonymous 7:15

    Google? In 1990? Just how old are you?
    Do you recognize that acellular vaccine was not available yet, but soon would be?

  • Picker and Chooser

    Anonymous 12:18

    Where did you get the idea I didn’t vaccinate my son, or was opposed to vaccination in general?

    My son got the usual complement of vaccines, minus the old version of pertussis vaccine.

    No one has yet answered this question:

    Would you fire a patient for refusing hepatitis B vaccination for an infant?

  • Anonymous

    Well then tell me how you did a complete “risk assessment” that completely goes against national expert opinions. Please don’t give us some Jehovah Witness literature.

    PS: Tell you what, why don’t you “do a little research” and look up the percent of hep B infections advance to cirrhosis.

  • Picker and Chooser

    I made an individualized decision. I had access to more information about pertussis controversies and the limitations of the vaccine, and the newer vaccine on the horizon, than most people. While public health concerns about people taking a free-ride on the vaccinated immunity of others are legitimate, I was willing to do it for the sake of my baby, in that time and that limited circumstance. Today the concerns I had are mooted by the availability of DTaP.

    Vaccinating infants for Hep B may make public health sense, my understanding is that it is promoted mainly to prevent maternal transmission. However, many individuals know they do not engage in high risk activities that spread the virus and/or that they do not cary the virus. Their own infants risk of exposure to Hep B is vanishingly small, since health care workers are all vaccinated.

    To some individuals the need for Hep B vaccination is at least questionable. Most patients want to be treated as individuals, not as part of a herd.

  • Anonymous

    The numerical risks cited may very well be accurate but it is not the whole story. Doing something (giving the vaccine) that results in harm may leave the parents with a lot more guilt and sense of responsibility than having harm befall a child because of inaction.

    Think about those psych experiments that ask people if they would divert a train that was heading for 5 people onto a siding where only 1 person is standing. Many don’t choose to divert the train.

    As for the way you mockingly use the seatbelt analogy, I guess you’ve been lucky enough to never see it. I fully understand seatbelts save lives and my kids are always buckled up but as for me… A couple of years ago on Sunrise Highway in New York I watched a woman burn to death in the front seat of her car after a bad accident as bystanders couldn’t pull her out through the window because of her seatbelt. I don’t think any of the 50+ people standing there will ever forget the screams. I’ve never buckled up again.

    My children have, of course, had all their vaccinations.

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