Feuding Over Vaccines: Doctors Vexed by Parents' Refusal

This news article explores the implications that immunisation-related myths circulating on the internet can have for parent-pediatrician communication, and, ultimately, for the continuation of the patient-physician relationship. Some parents are gathering, though their own research online, information suggesting that the dangers of immunisations outweigh their benefits, and that there is a conspiracy by drug companies, doctors, and vaccine makers to conceal the harm. Convinced by these "myths", some parents are refusing to have their children immunised.

As reported in the piece, a team of pediatricians from 3 major Chicago, Illinois (USA) medical centres surveyed more than 300 of their colleagues around the country about their attitudes toward such vaccine refusal. Slightly more than 50% of pediatricians said that in the previous year they had encountered at least one family that refused all vaccines, while 85% said they'd had a parent turn down at least one shot. More striking, in the mind of one member of the research team - pediatrician and ethicist Erin A. Flanagan-Klygis - were the findings that 39% said they would consider turning away a family that refused all shots and 28% said they would think about severing a relationship with a family that refused some shots.

This issue of termination or dismissal of patients or families due to differences of opinion with regard to care is "seen as particularly problematic in pediatrics because of the fear that helpless children may be deprived of care." One pediatrician and ethicist quoted in the article notes that, despite these risks, the American Academy of Pediatrics has concluded that such dismissal is permitted "when a substantial level of distrust develops, significant differences in the philosophy of care emerge or poor quality of communication persists."

It can apparently be difficult to clear up misunderstandings about vaccines prior to the finality of "dismissal" due to the fact that parents are reluctant to communicate their concerns - for fear of reprisal. One parent quoted here who is against immunisation explained that "parents don't want to discuss it with the media because of harassment" by authorities.

Flanagan-Klygis seems to suggest that one-on-one parent-physician conversation can be a key strategy in helping address the myths and preventing dismissals. In an effort to improve the quality of parent-physician communication around the issue of vaccines and vaccine refusal while in her own practice, Flanagan-Klygis asked one family to bring her all the anti-immunisation information (books and websites) on which they were relying. She said she was "blown away" by how false this information was. Her strategy in that case involved holding a series of meetings with the parents to discuss their concerns. She also referred them to reputable sources of medical information. Over a period of 6 months, she talked with these parents about how strongly she felt about vaccines. "By entering a dialogue, you allow parents to feel they're being respected," she said. "But what I did takes a lot of time and resources that practices probably don't have." Nor, she added, are insurance companies likely to pay for such appointments.