Doctors "Firing" Parents for Not Vaccinating

Earlier today, I read a blog post by a mother whose son's pediatrician referred her elsewhere because of her decision to delay (and possibly forgo) vaccination. I remembered a recent article that discussed this very issue, and summarized it to leave as a comment. I think it's interesting enough to share here...

As it turns out, it isn't uncommon for physicians to drop patients whose parents delay/selectively/don't vaccinate.

A 2005 study found that "39% of pediatricians said they would dismiss families who refused all vaccines; 28% would dismiss families who refused select vaccines or delayed vaccine administration".

The study went on to ask those pediatricians their reasons for dismissing the families. Here's what they found:

• 82% - lack of shared goals
  
• 73% - lack of trust
  
• 27% - type of vaccine refused
  
• 15% - fear of litigation

Source: Flanagan-Klygis, et al. "Dismissing the Family Who Refuses Vaccines: A Study of Pediatrician Attitudes." Archives of Pediatric and Adolescent Medicine. 2005;159:929-934.

The study didn't try to say whether it was right or wrong to dismiss patients, it just set out to describe the situation. However, the journal also published two letters written in response to the sudy, one supporting doctors who drop patients, and one admonishing them. Here are excerpts from each.

First, is Michael P. Elston, MD, MS, of Western Health, in Rapid City, SD:

Following the lead of a pediatrician mentor of mine, I would exhaust all efforts to provide cogent arguments to support the proven safety and effectiveness of these most successful preventive regimens. When these arguments failed, I advised these well-meaning but misguided parents that they were asking me to "voluntarily contribute to the death of their child from a disease we could prevent"; an ethical breach they could not ask of me.... [The authors of this study] bring voice to the ever-present need for physicians to advocate for the highest-quality care for their patients.

Next, Kathi J. Kemper, MD, of Wake Forest University School of Medicine in Winston-Salem, NC:

How can physicians dedicated to patient-centered care "fire" families who make independent health decisions? We are not generals demanding obedience; we are servants of life, of free human beings. They come to us for help, not demands to do it "our way or the highway."

What's next? Will we fire families who let their children watch more than the "maximum" of 2 hours of television daily? Fire parents who let their children ride in the back of pick-up trucks? Fire parents who do not feed their children at least 5 servings of fruits and vegetables daily? Or just those who serve less than 3? Or those who overfeed their children and allow them to become obese? Or those who don't have sufficient funds to buy food or shelter and have hungry, homeless children? Or those of different religious or cultural or racial backgrounds?

On just what part of the Hippocratic oath or conventional medical ethics are we relying when we make such decisions or are they based purely on a sense of self-righteousness?

I don't agree with delayed/selective/non-vaccination, and can understand where the physicians who drop families are coming from. However, I agree with Dr. Kemper's analysis that doctors don't "fire" patients for any number of other activities that go against commonly accepted medical standards, and vaccination shouldn't be an exception. Doctors should try to explain their concerns and the current science, make sure that everyone's wishes are documented, and continue to treat the patient to the best of their ability.

Full disclosure: I am probably not the most unbiased observer on this issue, given just how many of my previous or current activities have been closely related to the vaccine debate:

• I worked at a school for children with autism, where I interacted closely with the children and had regular contact with their parents, many of whom were active in the non-vaccination movement.
  
• I have a "Little Brother" with a developmental disability on the autism spectrum
  
• I once treated children exposed to whooping cough while working at a hospital.
  
• I currently work at a medical research lab, at a school of medicine & public health, in a division that specializes in the transmission of disease
  
• I am the NCOIC (Non-commissioned officer in charge) of the immunization clinic at my Air National Guard medical unit.

Mass Pike U-Turn Ramp

Did anyone catch the Globe's article about the new u-turn ramp on the pike? It cites an outrageous statistic:

"... the Turnpike Authority redesigned signs leading up to the ramp to more clearly spell out who could use the ramp. Police still wrote 986 citations there Oct. 16-26, when regular patrols on the ramp ceased."
[my emphasis added]

Seriously? That's an average of 90 citations per day.

I've been wondering about the project ever since construction started on it over a year and a half ago. When the Globe covered it back in February, it seemed like a pretty good idea, but there was no mention of restricted use.

Maybe I missed something in this week's article, but it seems that the only reason it's not open to all vehicles is that nobody at the Turnpike Authority ever had it reviewed for environmental impact.