Don't be surprised if you start hearing a very hard line from your family doctor. Increasing numbers of physicians are turning away families that refuse to vaccinate, and it's not always in a pleasant tone. Pediatricians are even going to so far to hang a sign indicating "get out of my office" for those parents who refuse to vaccinate.
Educating parents about the importance of vaccinations is the key to change, according to Dr. Andrea Paul of BoardVitals, a board training resource for physicians. Dr. Paul suggests, "we train pediatricians to 1) explain the importance of the vaccines and 2) dispel any claims that CDC-advised childhood vaccines are linked to autism or developmental disorders."
Even for parents that plan to vaccinate children, physicians face the waiting room dilemma. Patients with compromised immune systems sit side by side with patients who may not have received all of the physician-recommended vaccinations. Thus, those at higher risk for contracting diseases, such as infants who are too young to be fully vaccinated, are at risk in the waiting room.
Furthermore, the Centers for Disease Control and Prevention (CDC) warns parents that they should "Be aware that your child can catch diseases from people who don't have any symptoms ... You can't tell who is contagious."
Dr. David Fenner of Children's Medical Group spoke to the Wall Street Journal. After talking with a family and they still refuse to vaccinate, Dr. Fenner explains, "there are so many things we're not going to see eye-to-eye on," and has since fired several families after implementing the policy practice five years ago.
Dr. Harry Miller, a pediatrician in Clifton Park, N.Y., decided to stop treating unvaccinated children in his practice in 2010. He says, "Exposing that small percent who don't vaccinate to those who do is a disservice."
For those who have chosen to delay or reject vaccines for preventable diseases, physicians have said they actively seek to protect other patients. Several physicians make it very clear to patients, even in early visits, that the unvaccinated are unwelcome. Upon first glance, such treatment may seem unethical; however, the American Association of Pediatrics (AAP) in an effort to protect patient lives has deemed it ethical to dismiss patients who refuse vaccination.
Physicians are asked to counsel with parents about children's vaccination schedule and answer questions; however, AAP reports that, "within a 12-month period, 74 percent of pediatricians report encountering a parent who refused or delayed one or more vaccines."
If children remain unvaccinated, insurance companies could cover some of the additional costs of a home visit or alternative arrangement. This raises the fairness argument, however. Why should other families pay for the cost of a potentially harmful decision for the community?
Another possible solution is for physicians' offices to have separate facilities for unvaccinated patient populations. However, in a time when insurance reimbursements are down and office sizes shrinking, such solutions aren't pragmatic for the near future.
In the mean time, physicians have an obligation to teach patients about the benefits of childhood immunizations, and we can only hope for more widespread adoption.
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