- A new survey reports that half of pediatric offices and one-third of pediatricians won’t treat families who refuse to have their children vaccinated.
- The doctors say their policy is to protect other families who come to their offices.
- Some pediatricians who keep unvaccinated families as clients say they do so in hopes of convincing the parents to have their children immunized.
Parents who refuse to have their children vaccinated could find it harder to find a pediatrician.
Among pediatric offices, 51 percent now have a policy of dismissing families who won’t vaccinate their children, according to a survey published in the Journal of the American Medical Association.
More than a third of pediatricians personally dismiss families when parents refuse childhood vaccinations.
It’s a growing trend.
In 2012, only 21 percent of pediatricians reported dismissing families for vaccine refusal.
These policies are more likely to occur in private practices than in community or hospital-based clinics and health maintenance organization settings.
Maintaining a safe environment
Dr. Richard Pan is a pediatrician and a state senator representing District 6 in Sacramento County, California.
Pan told Healthline that pediatricians really don’t want to discharge families from their practice but feel they must to protect everyone else.
“As pediatricians see increasing rates of vaccine-preventable diseases, they’re coming to the conclusion that, unfortunately, they’re not able to take care of a child because they don’t want to endanger other families,” said Pan.
“The safety of all children in the practice is the top concern on pediatricians’ minds,” he added.
Others at risk of exposure include newborns and younger children who are not yet fully vaccinated, as well as those with chronic health conditions.
The doctor-parent relationship
Pan says there’s also a matter of trust involved.
“People don’t realize how much time pediatricians spend talking about the importance of vaccines. Unfortunately, we spend a lot of time debunking misinformation, sometimes the entire visit,” he explained.
“The issue becomes if you won’t believe me about vaccines what will you believe?” said Pan.
Dr. Alix Casler is a pediatrician at Orlando Health Physician Associates in Florida and chairperson and medical director of quality of the group’s pediatric department.
“For some, it undermines the doctor-patient relationship that parents don’t trust them to sift through the scientific information and understand what is fact and what is fiction,” Casler told Healthline.
“It’s very disconcerting and takes a huge emotional toll,” she said.
Casler believes that when people understand how passionate physicians are, they’re open to listening.
“Not to force, not to coerce, but to help people understand. I’m very fortunate to have close communicative relationships with my families. Relationships between pediatricians and families are generally very close and full of mutual respect,” she continued.
Some parents are not against getting vaccines for their children, but they do want to delay them.
In general, Casler is not open to that.
“If there were a better, safer way to vaccinate, that’s what we would be doing. It’s based on medical evidence and science we are all very clear on. There’s no doubt in the minds of pediatricians that vaccinating according to the CDC vaccination schedule is the best way to protect children,” she said.
“If push comes to shove and there are unusual circumstances, we’ll consider it. If it’s a matter of maintaining that alliance and protecting kids and not putting them at significant risk, we’ll try to help people along. We’re just trying to do the right thing for our patients,” Casler said.
Keeping the door open
While Casler’s practice does dismiss families who won’t vaccinate, she understands those who don’t.
“There are physicians who want to keep these patients and continue to try and educate them because maybe one day they’ll get another chance. I respect them,” she said. “It’s a difficult choice and they’re hoping through hard work and education they can get that child protected.”
“I think that every pediatrician, regardless of which side of the line they fall on, sees the other side. It makes sense that part of you would want to keep a family forever and try and try and hope that one day, for some reason, what you said made a difference and a parent chooses to protect their child,” she added.
“I think all of us respect each other’s point of view on that. I guess the group I can’t respect are those who just don’t care,” Casler said.
“Unvaccinated children still need healthcare, and doctors still want to provide it to them,” said Pan.
“That’s the struggle we’re having in internal discussions in the profession. Most of us, I think, want to try to make ourselves available, but at the same time, we have to ensure that the other families who come to our practice are safe. That’s the dilemma,” he said.
A gut-wrenching decision
It’s an emotional, many-layered issue for all concerned, according to Casler.
“People think we’re arrogant and forceful, but we’re distraught. We lose sleep over it. In our practice, we’re clear from day one when someone makes the phone call that we follow vaccination guidelines. If you have questions, we will give you information. We’ll talk to you and hold your hand. But if it’s your choice not to have your children vaccinated, we’re not the right office for you,” she explained.
It’s not a decision taken lightly, but Casler is motivated to keep all her patients safe.
“We have immunocompromised patients who can’t receive vaccines for medical reasons, and infants and small children who are not yet completely vaccinated. Because of an unvaccinated child, somebody else’s child could die,” she said.
“We’re always aware of the fact that it may not be the best decision for that one individual patient we are discharging through no fault of the child’s. We carry this guilt that we’re letting this child go from our care when we know we could take good care of them and, at the same time, protect our other children,” said Casler.
What parents need to know
Pediatricians don’t vaccinate because legislation tells them to or because schools require it, said Casler.
“We vaccinate based on clinical-practice guidelines. No one wants to lose a patient to a vaccine-preventable disease,” she said.
“Most patients are vaccinated, so the bad stuff isn’t always on our radar, especially younger physicians who may have never seen these diseases and may not think to check for them,” Casler added.
Pan noted that immunization rates have dropped even further due to COVID-19 concerns.
“Measles outbreaks pre-COVID were concerning enough. I hope we don’t have larger outbreaks. But we need to draw a line. We can’t endanger other patients. And this is the year when everyone should get a flu shot,” he said.
If you’re concerned about your own pediatrician’s practice, you can check the overall vaccine rate in your community or talk to your pediatrician.
“If your child is at high risk due to conditions such as an autoimmune disease or cancer, it’s worth having the conversation with the doctor. Pediatricians are very concerned about this, including the ones still seeing unvaccinated children,” Pan said.
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