Some pediatric practices refuse to provide care for children with vaccine-hesitant parents.
Those pediatricians are quick to offer rationalizations for this decision. Many of their reasons are compelling. I’m confident you yourself are thinking of some right now. This piece isn’t intended to be a deep dive into those reasons. No justification for refusing care to certain children changes the outcomes.
We assume that these families end up at organizations like mine: small non-profit community health systems or academic medical centers. And that’s fine, right? Somebody will provide care to these families, right? That’s the case, usually. I, and physicians like me, provide care to these children when our colleagues won’t. Kids everywhere deserve evidence-based care, and physicians are willing to give it to them. Care shouldn’t be withheld from them because their parents are currently hesitant about vaccination. With varying levels of mistrust in our health system, these families benefit from a close relationship with a physician. How else will their doubts be addressed?
We assume that these families wind up at my clinic. That’s not always the case. After being refused by one or more practices when trying to find their child a doctor, vaccine-hesitant parents sometimes wind up with quacks caring for their children. Children deserve actual physicians whose care is informed by evidence. Instead, some families that start out as vaccine-hesitant wind up with chiropractors and naturopathic “physicians” caring for their kids. Jilted parents who may have only been a bit hesitant about vaccines wind up in “clinics” with charlatans that have a financial interest in furthering their mistrust in evidence-based medicine. Even worse, they sometimes wind up with those medical doctors that have chosen to put aside evidence for profit. Kids lose when they have the type of doctor that testify before state committees that COVID vaccines make you magnetic.
Those families outside of evidence-based medicine sometimes wind up at my clinic urgently when their child develops a serious illness. (And after snake oils and chiropractic manipulation have failed.) Pediatric specialists have certainly experienced the same thing: How are our oncology colleagues supposed to acutely build trust with these families when prior pediatricians wouldn’t give them the time of day?
Non-accepting physicians will claim they’re protecting their established patients with cancers and immune system issues. At face value, that justification is compelling. But, what about my patients with cancers and immune system issues? Private practices often have to limit the number of patients with Medicaid insurances to make ends meet. But, does every private pediatrician that practices this truly allow as many Medicaid patients as finances allow? This combination results in an undue burden on children from lower socioeconomic levels: poor kids with cancer have a higher chance of the feared scenario of encountering a vaccine-preventable disease in my waiting room than they otherwise would if all pediatricians served all children.
The non-acceptance of vaccine-hesitant families has never been more dangerous than now with the polarization of COVID-19 vaccines. I’m sure non-accepting physicians are quick to tell friends and family, or post on social media that doctors should be trusted; listen to your doctor, not this celebrity or that politician. How can we as physicians ask patients to trust us when some of us refuse to even work with the vaccine-hesitant in the first place?
The above implications of refusing care to children of vaccine-hesitant parents aren’t the only ethical considerations for abandoning this practice. I encourage anybody interested in checking out a piece from Pediatrics published in December 2020.
The non-acceptance of vaccine-hesitant families is a problem in pediatrics. Its solution is an easy one. If your practice currently observes this policy, I recommend you seriously consider how you’re affecting mistrust in medicine and children’s health everywhere.
Sean Gallagher is a pediatrician. He can be reached on Twitter @TheKidKidDoc.
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