Should Pediatricians Refuse to Treat Unvaccinated Families?

Photo by Corbis

Search for the words “Infectious diseases” online and you’ll be inundated with an onslaught of scary information. There are 37 confirmed cases of measles in seven states. In California, 30 babies have been placed under home isolation due to possible exposure to measles after a December outbreak at Disneyland. There’s the whooping cough epidemic, the largest outbreak since 1955. And the flu, a virus responsible for hospitalizing nearly 10,000 people since October, shows no signs of slowing.

Still, the raging debate among parents about whether or not to vaccinate children continues. Proponents say immunization helps contain deadly diseases and stand by the effectiveness and safety of modern vaccines. Conversely, many so-called “anti-vaxxers” fear autism due to a discredited 1997 study linking the MMR vaccine (which prevents measles, mumps, and rubella) to autism. Although the study author lost his medical license due to falsifying data, the research instilled widespread fear of vaccines that persists today. Other parents fear that vaccines contain antigens, or they subscribe to a holistic approach to medicine that doesn’t include vaccines.

And while the two groups don’t agree on much, there is one place they share common ground: the pediatrician’s office.

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There are no official rules pediatricians must follow when it comes to treating families that won’t vaccinate, but many doctors reinforce recommendations by the American Academy of Pediatrics (AAP) which state: “Vaccines save lives and protect against the spread of disease. If you decide not to immunize your child, you put your child at risk. Your child could catch a disease that is dangerous or deadly. Getting vaccinated is much better than getting the disease.” According to the Wall Street Journal, a 2011 study found that 30 percent of doctors in Connecticut had asked families to leave their practices for refusing vaccines; another survey of 909 pediatricians in the Midwest declined to treat 21 percent of families with anti-vaccination beliefs.

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One such example was made public this week when a Reddit user posted a photo of a note hung in her pediatrician’s office. It read: “Although I respect each person’s free choice, I have a bigger responsibility to all of the patients I care for. Because of this, the office no longer accepts new patients who have decided not to immunize their children.”

Photo by Reddit

“For many doctors, convincing parents to vaccinate their children consumes precious time and resources, particularly when providing immunizations is poorly compensated by some third-party payors,” Rodney Willoughby, M.D., a Wisconsin based pediatrician specializing in infectious diseases, tells Yahoo Parenting. “In the meantime, you have unvaccinated children sitting in waiting rooms who pose a threat to other patients and the staff.”

Some practices work with parents on the fence about vaccination, by altering schedules to delay shots or space them apart, a highly controversial pick-and-choose method which is not backed by medical science and leaves children exposed to disease. Other doctors avoid the issue altogether by outlining their vaccination requirements in initial medical contracts.

“In reality, there are only about three percent of families staunchly against vaccination,” says Willoughby. “Unfortunately, research shows that the more doctors try to convince them to vaccinate, the more strongly they hold onto their beliefs.” The other ten percent, he adds, can be swayed to vaccinate, especially when doctors use specific verbal tactics. Sharing anecdotes of unvaccinated patients who have gotten sick, presenting the vaccination schedule in a matter-of-fact tone of voice, and sharing personal philosophies on the topic, can sway up to 50 percent of families to vaccinate.

Most importantly are the people who most often get lost in the vaccination debate: The kids. It’s one reason Willoughby says many pediatricians don’t give up on treating families who won’t vaccinate. “There are plenty of chances to improve a child’s health when doctors continue to engage parents on the topic,” he says.

It’s a dilemma also posed by Connecticut pediatrician Sydney Spiesel in her recent essay for Salon. “It’s a difficult question,” she writes. “If we don’t allow unimmunized kids in our practice, where will they get medical care?”

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