Walking parents through the decision to vaccinate their children is a conversation. The vast majority of the time it is an easy conversation. Sometimes it is difficult.
If the conversation goes like this, then we, as doctors aren’t doing our jobs:
Pediatrician: “Are you going to vaccinate your child?”
Pediatrician: “Get out of my office.”
The medical community has lost a lot of ground on communicating the necessity of vaccines. For years, we told our patients “now it’s time for the shots” and our patients signed consent forms and stuffed vaccine information sheets in their bags. We walked out of the room, leaving our staff to inject. We didn’t talk about the diseases we were preventing. We didn’t talk about the millions of lives we were saving. We made huge gains in preventing illness, and it was so easy.
Then, the landscape changed. Bad science gave parents doubts. Horrible diseases were controlled in the developed world, and we forgot to be scared. People with various axes to grind played on people’s fears and beliefs, using them to skew risks without talking about benefits.
In addition, society changed. Patients were empowered to be a more active part of healthcare decisions but weren’t given the tools they needed to do it well. Pop culture and the 24/7 news cycle spawned an unhealthy mix that made celebrities appear to be health experts. Stories about risks in medicine made great headlines; stories about benefits were only aired if they were new or ground breaking.
These intertwined forces left us where we are now, and we cannot turn our backs on the children who are caught in the mess. While I understand the thinking of my colleagues who feel differently, we must not turn children away because their parents are not planning to vaccinate.
If we turn away families who do not plan to vaccinate, we have shut the door on the conversation. We guarantee those kids will have the opportunity to be infected by vaccine-preventable illnesses and spread them to others. We will be sending them to providers who don’t care about vaccines or who are anti-vaccine (and who knows what other medical precepts they don’t follow). Worse, we may be, pushing them out of getting non-emergency medical care at all.
I have taken care of many families who refused to vaccinate their children, at least initially.
This is how I approach vaccines.
I tell people, “now is the time for today’s immunizations” or, if it’s a prenatal visit, “here is the vaccine schedule.” Some medical providers will ask families if they want to vaccinate, but I don’t ask if I can listen to a baby’s heart or see if it’s ok to check her development, so why would I ask about vaccines?
If parents are concerned about or outright reject immunizations, we have a conversation. “I’m surprised. Nearly all my patients vaccinate their children. I vaccinated my son to protect him from all those diseases. What are your concerns?”
I try to give them good information and clear up misconceptions. Sometimes they will ask questions or offer objections that I can’t answer on the spot, and I tell them I need to do some research. I never give answers I’m not sure about and I never make claims I can’t back up.
If they are still not convinced, I tell them we will keep talking about it. I encourage them to follow the well-researched guidelines of every health organization in the world.
Then, I tell them that I find vaccinating children to be so important and such a core of pediatric training and practice, that I have made rules for families who aren’t ready to vaccinate yet.
Here are the rules for the families who aren’t ready to vaccinate yet and for me:
- At every applicable visit, I will recommend vaccines by the recommended vaccine schedule (I won’t harp on it at a visit about an injury or during an emergency, but I will discuss it virtually every other time.)
- Parents need to share their information sources with me. I will fact check them and provide alternative sources of accurate information when I find inaccuracies. I will tell them when I’m not sure or when I don’t know something.
- Every time their child has a vaccine-preventable illness or I have to do an unnecessary lab test because they aren’t vaccinated, I will remind them of their decision and recommend vaccination.
- I will treat parents respectfully, and they will treat me respectfully. I won’t be condescending or dismissive, and they won’t accuse me of endangering children or getting rich from Big Pharma. If they change their mind about vaccinating, I won’t say, “I told you so.”
- Their child and unvaccinated members of their family will need to wear a mask at every sick visit or any time they come in with a rash, cough/cold or fever.
Some families, when they hear and experience these rules, have chosen another provider. Most have stayed. Virtually all of them have, eventually, gotten their children fully vaccinated. It’s a lot of work (and I’ve been lucky to work in settings that gave me adequate time), but vaccination is so important, we have to keep the conversation going.
Andrew Cronyn is a pediatrician who blogs at Parents for Vaccinations.
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