When doctors dismiss families for refusing vaccines, parents are sometimes swayed, the survey revealed. In fact, 18% often or always change their minds, while another 48% sometimes do. Twenty-nine percent rarely change their minds, and 5% never do, according to the surveys.
The report found that private practices were more likely than community, hospital-based or health maintenance organizations to have a dismissal policy. Practices in the Midwest were less likely to have dismissal policies than practices in other regions.
Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said the goal of dismissal policies is to make sure children get vaccinated. He was not part of the study.
“By drawing a line and saying, ‘I can’t see you if you choose to delay or refuse vaccines, because you’re asking me to practice substandard care,'” Offit said. “‘Were this child to be hurt, I — at some level — would be tacitly responsible, because at some level, I would be saying it’s OK, if I continued to see your family.'”
Pediatricians also have a responsibility to all of the children in the waiting room. “Sometimes, kids in the waiting room can’t be vaccinated — they may be too young, taking certain medications or be immunocompromised,” Offit said.
The big concern, though, is that doctors don’t know where a child might end up if they dismiss them.
“I don’t think there’s any really good choice in this situation for pediatricians. It’s very hard,” Offit said.
O’Leary said he hopes parents understand that “many pediatricians feel so strongly that the benefits of vaccines far outweigh the risk that they are willing to take the extreme measure of not taking families who refuse to vaccinate. And, remember, these are people who have devoted their careers to taking care of children.”
He said many questions remain and this topic needs further study. For example, do dismissal policies help with vaccination rates? What message do these policies actually send to the parents?
The findings were published Sept. 15 as a research letter in Journal of the American Medical Association.
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SOURCES: Sean O’Leary, M.D., M.P.H., professor, pediatrics, Sections of Pediatric Infectious Diseases and General Academic Pediatrics, and investigator, Adult and Child Consortium for Health Outcomes Research and Delivery Science, and director, Pediatric Practice-Based Research Network, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora; Paul Offit, M.D., director, Vaccine Education Center, and attending physician, Division of Infectious Diseases, Children’s Hospital of Philadelphia;Journal of the American Medical Association, Sept. 15, 2020
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