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Facing the dilemma of dismissing vaccine refusers :

August 29, 2016

Dr. RucobaDr. RucobaThe parents were college-educated and lived in a fairly affluent suburb. Their first child was 2 months old, and we were discussing immunizations again.

The parents were refusing all vaccines but could not elucidate a cogent reason for their refusal. The baby’s grandmother was in the room, too.

I had tried using statistics and science in the first two visits, to no avail. This visit, I decided to put a human face on the issue.

I spoke of the measles epidemic I witnessed as an intern in 1989 during my first rotation on the infectious disease floor. I told them about a young boy who came in with measles, deteriorated and ultimately died. I related the story of another patient who entered the hospital as an energetic, playful toddler, but left neurologically devastated and dependent on a tracheostomy and G-tube feedings.

After a pause, the grandmother forced a smile and said, “You’d make a good salesman.”

I knew I had lost them.

I didn’t continue. I didn’t even try to tell them I wasn’t making a “sale” but was trying to protect their newborn’s life.

After scores of similar encounters, the nine providers in our independent, private practice agreed to formulate a policy on how to deal with vaccine refusers. We discussed dismissal as an option for those who absolutely refuse all vaccines. We agreed that if a family didn’t trust us on this issue, then the relationship was built on a poor foundation and unlikely to hold up if more complicated medical situations arose. And as a practice with a large number of children with special needs, we didn’t want to expose everyone in the waiting room to vaccine-preventable illnesses.

We also were conflicted, since the Academy did not endorse patient dismissal for this reason.

In the end, we decided to dismiss the small minority of patients who we would never convince to get vaccinated. We would work with other vaccine-hesitant parents, such as those who received some but not all recommended vaccines and those who wanted nonstandard schedules.

Our policy states that if the child does not get vaccines required by the state, then they need to find another health care provider.

After that ultimatum, many families who refused or delayed vaccines got the required shots. But some did not. We dismissed them and offered names of other practitioners they could call.

At first, I felt a little odd telling patients about our policy, although I strongly agreed with it. But after talking with friends and colleagues all over the country, I realized we were part of a trend.

Families who fully vaccinate their children have thanked me for the policy. Those with children who are medically restricted from getting certain vaccines are particularly grateful.

Talking to families about possible dismissal is not easy. But I know it’s the right thing to do for the health of all the children in our practice. And I’m glad to finally have the Academy’s support.

Please see related article "How to address vaccine hesitancy: New AAP report says dismissal a last resort."
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