Are doctors contributing to the polarization surrounding vaccines?

Why is it that illnesses that could be prevented by vaccination are on the rise despite scientific evidence they save lives? Recent articles noted measles exposure to people riding the Bay Area Rapid Transit (BART) public transportation system as well as more cases of whooping cough due to refusal to vaccinate and in some cases getting “non-medical” personal exemptions. The suggestion that vaccines could cause autism has been debunked. So why is this happening? Will more cases of preventable illnesses make the news?

If we look at the research from Frank Luntz, the answer is yes.

Frank Luntz would hardly be the right person to ask. Luntz is known for his work, particularly in politics, for polling and interpreting what the American public wants to hear. Luntz has a knack for advising Republican candidates, corporations, and speaking on Fox News and CBS. Though he is a professor at the University of Pennsylvania, he isn’t in health policy. He isn’t a doctor.

What he is, however, is the best person to gauge the pulse of the American public. This perspective of what is happening in America should have doctors concerned. This is why vaccination rates will continue to fall.

As the Atlantic article, the Agony of Frank Luntz, notes:

  • [Luntz] not sure what to do. He’s still going through the motions — giving speeches, going on television, conducting focus groups, and advising companies and politicians on how best to convey their message …
  • “I spend more time with voters than anybody else,” Luntz says. “I do more focus groups than anybody else. I do more dial sessions than anybody else. I don’t know shit about anything, with the exception of what the American people think.”
  • It was what Luntz heard from the American people that scared him. They were contentious and argumentative. They didn’t listen to each other as they once had. They weren’t interested in hearing other points of view. They were divided one against the other, black vs. white, men vs. women, young vs. old, rich vs. poor. “They want to impose their opinions rather than express them,” is the way he describes what he saw. “And they’re picking up their leads from here in Washington.” Haven’t political disagreements always been contentious, I ask? “Not like this,” he says. “Not like this.”

Would America be better served if we were listening? What might that look like?

  • “I don’t like this. I don’t like this,” he says, meaning D.C., the schmoozing, the negativity, the division. At football games, “People are happy, families are barbecuing outside, people are playing pitch and toss. A little too much beer, but you can’t have everything. They’re just happy and they’re celebrating with each other and it’s such a mix of people.” The first week of football season, he went to four [NFL] games in eight days: Sunday night, Monday night, Thursday night, and then Sunday again.

Why does this matter?

Increasingly we are seeing doctors kick patients out of their practice because patients (often parents deciding for their children) don’t agree with getting vaccinated.  I do understand the reasoning. Is it the right thing to do?

If doctors are increasingly adding to the polarization, how are we going to build long-term relationships that engender trust?

  • Can’t we respectfully disagree and tell patients that as we continue to care for patients?
  • Can’t we continue to gently remind patients at every encounter to get vaccinated even when they said no the first one hundred times?
  • Can we stop writing immunization exemptions in record numbers for non-medical reasons?

Surveys demonstrate that doctors are still among the most respected individuals that the public looks to. Sometimes doing simple and difficult things like saying no to exemptions, reminding patients that we care and will continue to remind them about immunizations even if yesterday and today they say no because tomorrow is another opportunity to say yes, builds trust and relationships.

Because organizations and politicians who don’t hear what Frank Luntz has to say often pay a price.

What the public is telling him is that America even more polarizing around many issues. We can assume that vaccinations will be one of these issues. Fewer patients wanting vaccinations will be a reality.

As doctors we not only need to continue to educate in person, via professional societies and social media, but also ensure that we do not contribute to this polarization and continue to learn and listen. If we do not, there is no chance that the rise of preventable illnesses will stop.

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.

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  • Gregory Dursteler

    If a patient won’t believe a physician on the topic of vaccination, what will they believe them on? What’s the point of being someone’s physician if they disregard everything you say? That seems like a waste of time for everyone involved.

    Inviting a group of people who aren’t vaccinated into your office poses very real risks to the rest of your patients.

    I can think of no intervention more justified by medical science than vaccination. If patients are going to reject it, is there really room for discussion on other complex medical issues?

    Trying to convince someone that they are wrong about something is generally a fruitless endeavor. The widespread persistence of irrational beliefs disconnected from reality should indicate how stubbornly capable humans are of believing things that are wrong. Even intelligent well-educated people can hold onto ideas diametrically opposed to reality.

    Maintaining universal vaccination is really a political question. No amount of badgering, love, or education can dissuade a human being from believing what they want to.

    • http://www.davisliumd.blogspot.com Davis Liu, MD

      Agree that if a person disregards everything I say that there isn’t likely a very therapeutic or helpful doctor-patient relationship. In my experience, rarely do we disagree around an issue or two where it is divisive enough to split that long term relationship. Patients do change their minds over time due sometimes as a consequence of my effort or others and other times to a circumstance or situation in their lives. Unless we continue to build long-lasting and trusting relationships will we have an opportunity to learn and hear as well as many times clear up myths as well as mistrust.

      • rbthe4th2

        True.

    • rbthe4th2

      “What’s the point of being someone’s physician if they disregard everything you say?” what if the only thing they have a problem with is vaccines? Everything you say is one item but if the parent only has this one item … it becomes obvious that it is a battle of wills.

  • http://www.ronsmithmd.com/ Ron Smith

    Hi, Davis.

    Re: “Increasingly we are seeing doctors kick patients out of their practice because patients (often parents deciding for their children) don’t agree with getting vaccinated. I do understand the reasoning. Is it the right thing to do?”

    I remember there was a Pediatric practice trend I heard about in Tulsa, where I did my residency some thirty years ago that was terminating their patient-parent relationships when moms didn’t breastfeed!

    That was truly unbelievable. These practices presumed that their reputation and polish as professionals and physicians could force mom’s to do something that they wanted despite almost forty years of healthy babies that resulted from formula feeding after World War II.

    Do I ever hear of a practices today that are so arrogant as to try an intimidate mom’s into breastfeeding? Absolutely not. That’s because breastfeeding is a choice and I’m pro-moms and can offer them advice on formula or breastfeeding which will help them focus on their primary concern-raising a healthy child!

    Vaccine encouragement and acceptance needs to take the same tack. We should not try and force vaccines. That is ultimately totalitarian and socialist.

    As I said in a previous article here on KevinMD.com (The failure of vaccine messages) I DO encourage and promotes vaccines. I have seen and believe in their effectiveness. The arguments of the detractors just don’t hold water.

    But it is a mistake to take that belief to the point that I’m forcing parents to accept a medical treatment in the same way that we dictate here in America that we drive on the right side of the road and not the left! Vaccines should be optional. Driving on different sides of the road in different cities or states would be deadly.

    So how do we promote vaccines effectively? Physicians must get off their high horse and develop meaningful relationships with families. Stop trying to dictate behavior. American’s don’t like that and I don’t in particular!

    Most of my parents who come to me with their own ideas about how they want to do the vaccine schedule or even whether to do vaccines are still my patients longterm. They often come to the conclusion that vaccines are a good thing as they hear me teach them throughout the early healthcare visits.

    The point is that vaccine promotion is about a good physician-parent relationship and that means mutual respect. I never in my mind think “how stupid can you get” when I work with these parents. I give them the benefit of the responsibility that they have and trust that as time goes on that our relationship will bridge those concerns.

    My goal is vaccine adoption, not imposition of my will on parents. I have decided that I’m going to like them even if I don’t think they are doing the smartest thing.

    The only way I see that we will change their minds is through relationship and not mandate. Mandates don’t work well in healthcare do they?

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • http://www.davisliumd.blogspot.com Davis Liu, MD

      Agree – thanks for your comments!

    • rbthe4th2

      Excellent post and thank you for your willingness to work with patients and not dictate to them. May many learn this attitude.

  • ninguem

    If insurance plans gauge a doctor’s “quality” against measurements such as vaccine rates, smoking cessation, etc., then don’t blame the doctor for dismissing a patient who makes the doctor’s aggregate numbers look bad.

    • rbthe4th2

      Will this help engender trust in physicians when it becomes more obvious that its the doctors’ will that matters and not the patients? That while the world says they are adults with a choice, in their medical care, they’re going to be forced into what one doctors’ morals and will is, and not their own? Based on the doctors’ morals, values and $$$, and not theirs?

  • siamesekat

    Unless or until anyone connected with the manufacture, distribution, sales, and administration of any vaccine product is willing to assume the financial responsiblity for the medical injuries which these biological products may cause — and frequently!, how may you coerce such a therapy onto any otherwise healthy individual, especially an infant?! How may you state to any parent that a vaccination is “safe and effective” when under federal law, all vaccines are legally classified as “unavoidably unsafe products?”

    How may you assert to know anything about vaccinations for that matter when according to Section 13.1 of every vaccine package insert, no vaccine ever is tested for carcinogenicity, mutagenicity, teratogenicity, or assessed for impairment of fertility? Just the type of medical therapy which anyone wants to administer to an otherwise healthy infant, isn’t it, especially when no physician ever discloses to the parents the fact that the vaccine contains known carcinogens and agents known to impair fertility! Moreover, no government scientist ever studies vaccines for these properties or other inherent lacks of safety either. Given these facts, and the fact that ALL that any physician knows about vaccine products is only what vaccine manufacturers and self-interested agents of government tell you, how do you in good conscience ever administer these products, especially to otherwise healthy infants and children?

    Have any of you ever read the cases in The Vaccine Injury Court or had a look at the billions paid out to the victims of vaccine injuries by the Vaccine Injuury Compensation Fund? Do you advise parents to do this research before you start jabbing away? And, you wonder why patients doubt your judgment regarding the risks and benefits of vaccinations!

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