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Childhood Immunizations: The Conversation That Must Continue

by Jeff A. Drasnin, MD, FAAP, pediatrics

There are a growing number of pediatricians around the country who will not provide care to families if they either a) refuse all immunizations or b) selectively immunize. While I would consider myself an academic pediatrician who, to the best of my ability, will always “recommend what is recommended”—following American Academy of Pediatrics (AAP) recommendations as well as evidence-based medicine—I’ve noticed an increase in “alternative families” at my group practice. More families like these are seeking me out to be their pediatrician, despite the fact that they have no intention in following some of the recommendations they know I will make.

Unbeknownst to me, I have become “that guy” in Greater Cincinnati, or should I say “that pediatrician,” the one willing to discuss alternative vaccine schedules and provide care to those who don’t vaccinate at all. When you Google “alternative vaccine schedule” or “no vax pediatrician,” along with “Cincinnati,” my name appears.

This was never my intention but I do carry this distinction with some pride. Providing care to this population subset is important and the number of pediatricians choosing not to based on philosophical grounds continues to increase. They recommend you find a pediatrician “who agrees with your views,” and politely ask you to pursue care elsewhere. Here, I provide the counterpoint: Despite not agreeing with certain decisions, we can (and should) still provide high-quality care to these “alternative families.”

For the record, I fully support full vaccination and have vaccinated my own children per prevailing recommendations from the AAP, Advisory Committee on Immunization Practice, and Centers for Disease Control. The majority of my group practice is still made up of more traditional families, who follow most vaccine recommendations without significant discussion.

Those who question vaccine recommendations do so for a variety of reasons. They come from a wide range of socioeconomic and religious backgrounds, as well as all races and nationalities. The one thing I have found amongst the majority of these families is that they want to ask questions and be respected for what they believe. Many of the alternative vaccinating families adjust the recommended schedule for emotional reasons; many who do not vaccinate at all have some deeper fundamental concern with the necessity or safety of vaccinations in general.

While most traditional, Western medicine-trained pediatricians (including me) are comfortable with the risk/benefit ratio of vaccines, we mustn’t deny primary care services if a family disagrees with us on this. I would like to present an alternative view for consideration, with all due respect for those who do not agree. Here are my counterpoints for continuing to care for these children and work with these families:

  1. If we all refused to see these patients, they would have no access to basic medical care. It’s not the child making the choice. One could argue further that the Hippocratic Oath of
    “do no harm” is violated here, as it can be considered harmful to deny basic primary care to a minor.
  2. Some pediatricians consider further discussions on the topic of immunization to be pointless. By refusing to have a conversation with a parent, how might we educate these parents so they can make a better-informed decision (even if it is not in line with our beliefs or prevailing norms)? After all, aren’t we really teachers most of the time?
  3. If we don’t respect others’ differing views, how can we expect others to respect our opinions?
  4. Do we really expect a parent to change his or her mind solely on our refusal to provide care? Aren’t we more likely to polarize them by taking this stance?
  5. The AAP has reaffirmed, multiple times, its recommendation NOT to discharge these families from your practice over this issue. Why do we generally follow their recommendations as gospel, but not this one?

Over the last 14 years of private practice, I have found that if you listen, families will too. Asking them why they feel the way they do helps us understand where their decisions come from. Even the most strongly opinionated parent often will listen to “your side” if you just ask (most of the time). Encouraging families to continue to “think,” to continue considering their decisions, to never close their minds, actually works.

What if they are unwilling to listen? Then, I ask again at the next visit, often with some humor, in order to break down walls so that serious conversations can occur. In situations where parents have refused all vaccines, I will ask sarcastically, “So… what vaccines will you let me talk you into today?” or “Which vaccine did you want to start with today?” I get a lot of funny looks but, on more than a handful of occasions, I will get an answer like, “Well, I was thinking about something,” or “What can you tell me about the __________ vaccine?”

I will always consider among my greatest successes the opportunity to educate a parent so he or she is better informed. For those who eventually listen and change course, the time spent talking to and working with the multitude of these families makes it all worth it. Changing minds is an uphill battle, but it can be done one step at a time. Success should be measured one child at a time.

I challenge my fellow pediatricians and primary care providers to join me in this quest. Help parents understand. Help children get appropriate care. The current generation wants to ask questions, to think, to be involved in the decision-making process. Ultimately, they want to understand why we recommend what we recommend. We should help them do this, even if we don’t agree with their conclusions—it’s a stance even the AAP stands by.

Why can’t we all be “that guy”? I could use a little more company. This gig can be lonely.

Dr. Drasnin is an athenahealth client specializing in pediatric medicine at ESD Pediatric Group in Cincinnati, Ohio.

Dr. Drasnin is an athenahealth client specializing in pediatric medicine at ESD Pediatric Group in Cincinnati, Ohio.

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