“Vaccines Why do some parents hate em? Who’s spreading the lies? What can sane people do to encourage these hipster parents to fall in line?” 

I asked Twitter to send me their burning parenting questions and decided to start a recurring series called Pediatrician’s Corner.  You can find all them here as they pop up.  If you want to ask a question that I’ll answer on this site, please email me or contact me via Twitter, Facebook, or Instagram.  If you send me a question privately (i.e. not publicly on social media), I’ll keep your name private.

Today’s question came courtesy of @MrIxtra on Twitter.

After he asked this question, I wandered onto a parenting forum called Motherhood.com and onto a message board for parents who are anti-vaccine.  One of the posts was about a pediatrician’s office that was banning families who do not vaccinate their children, with a parent lamenting the practice.

While I am in favor of vaccines,  I decided to post what I hoped would be a brief, non-threatening  reply.  This led to a little bit of a back-and-forth.  I posted some of the the discussion below.

You can click here if you want to read all of it as I did not include all back-and-forth (it does require making an account).  If you do end up reading the full thread — and I encourage you to read it — I request you just read and not engage in the conversation (I posted my final response on Nov 1).

This sub-forum is meant specifically for people who are anti-vaccine.  Though I believe I maintained a respectful demeanor and never criticized anti-vaccine views in my posts, it potentially pushed the spirit of the forum by entering it at all.  While I can be an argumentative SOB, the reason I posted on the forum was to learn and have a real conversation, not to tick people off.

Update: One of the posters from the original thread made a new thread where we can engage in a discussion in a place that should be open to all.

Initial Post from Parent

Just want to share our experience with you all. Yesterday we took our unvaccinated son to see his pediatrician for a checkup and also because we needed our Dr. to sign papers for our daycare.

I was able to take a year off and stay home with my baby after giving birth and now I am getting ready to go back to work next month.

Our doctor informed us that she will no longer be able to see our son since he has not taken his vaccines. He’s a perfectly healthy boy, we’ve been blessed with no issues this past 11 months “knock on wood”.

Even though we are “self-paid” patients the hospital (Mount Sinai) won’t allow her to see us anymore. She continue by telling us that the hospital is giving her 1 year to catch up all of her patients with all vaccines. If parents don’t comply in 1 year then we’re gone.

Just wanted to know if anyone else is or has dealt with this.

Rogue Dad Responds

As a pediatrician and pediatric ER doctor, I can tell you that nearly all pediatricians want all of their patients fully vaccinated.

For those families who refuse vaccines, it’s clear that the advice of the doctor is not trusted in these situations. The doctors do not want to be heavy-handed and recognize that arguing or battling families is not a successful tactic. Having a blanket policy that the doctor that it is a requirement to be vaccinated to come to the clinic is a bit controversial, but it also provides the doctor a way to avoid these battles with the families.

As the vaccines are something they support, it’s probably also silently supported by many of them.

Response from someone else

[Y]ou are in the wrong place. Just as you expect parents who do not vaccinate respectfully to leave your office and go somewhere else, we expect you to leave respectfully since you are not supportive of our stand nor are you offering support. 

Your background as a physician does not allow you come and state your purpose and agenda. 

We have heard it all before and do not care to hear it again. Move along. 

I may add that we have been nicer to you than some “professional doctors” have been to harried parents who have genuine concerns and are tossed out of vaccinating-on-time practices.

There are FOUR vaccine forums here – this one is not for you. 

But if you do post again, tell us how you personally treat a child and his/her parents in your ER who is not vaccinated or is on a selective/delayed schedule for vaccines and why. Furthermore, tell us how many vaccine adverse reactions you see in a week and how you deal those.

Response from yet someone different

Rogue Dad Responds

I have not attacked you nor your views, so perhaps you should look in the mirror. I do not have an office, I am not a primary care doctor, so I do not have any personal office policies regarding this matter.

I do however have insight into this policy that is causing many people here concern, so I am explaining SOME of the reasoning behind it, with the idea that it will HELP you decide how to proceed. Again, I have thick skin so you can use your ad hominem attacks all you want and it won’t bother me.

However I do encounter families in the pediatric ER where I work who do not vaccinate (I work in a children’s hospital with 55,000 visits a year in a medium sized city that sees a high acuity of patients).

I can tell you quite clearly how I deal with it: I ask if their child’s vaccines are “up to date” or occasionally ask about a specific vaccine if it’s relevant to their care (such as the flu vaccine during flu season when they have asthma or the Strep Pneumo vaccine for a young infant).

If I’m told their child does not have those vaccines because they do not believe in it, I make my treatment plan, and explain it. In some cases the lack of a particular set of vaccines mandates a change in my treatment plans because it places the patient at significantly higher risk for certain illnesses, thus requiring different testing, medication, observation etc. If that’s the case I will tell them that as well.

A very specific example as mentioned above: Strep pneumonia is the most common cause of bacteremia in young febrile infants. It’s normally given as part of a series at age 2, 4, and 6 months. Receiving even 2 of the first 3 of these vaccines significantly decreases the risk of blood infection from this bacteria. So if I care for a 4 month old girl with a high fever (~103) and where I cannot identify a source of infection for exam, in a fully vaccinated child I am unlikely to recommend or pursue blood tests. In a completely unvaccinated child, I am far more likely reo recommend blood tests (complete blood counts, blood cultures), because their risk of infection in the blood is substantially higher.

It’s not a punishment for not vaccinating, it’s providing the care the child needs. I frankly am happy to NOT perform invasive testing on any patient, but I will provide an honest assessment of their child’s risk for a given issue and there are some cases where the risk is higher.

If it doesn’t impact the treatment plan in that moment but I think the child would benefit from the vaccine regardless I’ll briefly mention it, i.e. a child with severe asthma who has not received the flu vaccine, I will tell them I recommend it because it reduces their child’s chance of severe illness from asthma and the flu. I FREQUENTLY see children with asthma who do not have flu vaccines, and I see them severely ill from the flu. Sometimes we see kids die because of it.

If they have questions I answer them. If they don’t say anything, then the conversation is already over. That’s basically it. So while I rarely have a discussion longer than 10 seconds on the topic, my focus is on the well being of the child, so I believe I should at least briefly mention this.

I quite rarely see adverse reactions to vaccines. When I do, it’s almost always a mild local inflammatory reaction at the injection site. Sometimes a mild cellulitis. I DO think I may have seen some children who have febrile seizures after receiving the MMRV vaccine, however not only is that quite uncommon, it does not cause long-term harm (though it is quite scary for parents).

My practice as an emergency department doctor is not the same as a primary care doctor. If an ill child is in my emergency department, my personal goal is to provide them the best care I am able to provide, regardless of the parental beliefs. Separately from that, I am legally obligated to treat every patient that requires emergent care (due to EMTALA, a federal law),

If an ill child is in front of me, I will provide them the best care I am able and allowed to provide. If a parent does not want a flu vaccine for their child (which we can provide in our ER), I don’t stop providing them care.

A primary care doctor is not legally obligated to continue to provide care to a family if the parent chooses to disregard their advice. The ethical obligation is a different question. Given alternative options and no harm to the child, many pediatricians believe they are doing a public service by having a strict policy, as in some cases it will push parents to do the vaccines. Other times they work with families on a modified schedule. In some cases they don’t do anything. Not every primary care pediatrician agrees with keeping anti-vaccine families out of the clinic. However if the pediatrician believes that providing the vaccines is a core, or THE core, aspect of their care, and that care is being refused, that would lead to them not wanting to continue a doctor-patient relationship.

If a cardiologist is seeing a patient with bad heart disease, and the patient refuses to take the medicine prescribed because they disagree and do not want any care for the heart disease, it is within their rights to stop seeing that patient in the clinic, just as it is within the patient’s right to refuse the medication and go see someone else who will recommend something different.

However “non-compliant” (i.e. patient just forgets to take the medication) and outright disbelief and refusal to follow the recommendations given are not equivalent. If a patient just wants to try a different blood pressure med or struggles with their diet, just about every doctor will continue to see them, and rightfully so.

Vaccines are viewed differently because refusing them is construed not only as potential harm to the person not receiving them, but increasing risk for those AROUND them. That is a fundamental difference between vaccines and diabetes, hypertension, cholesterol drugs, etc.

However to answer the most recent post regarding diseases coming back: you can believe or not believe in vaccines. However there are quite clearly documented outbreaks of diseases such as measles and pertussis (whooping cough) in recent years, concentrated in areas where people are starting to refuse vaccines. There are babies dying from pertussis.

One thing that hopefully comes through is the doctors banning families from the practice so feel so strongly about this particular issue they are willing to stop providing care for a patient when they would not do so for ANY other issue.

It’s not a slippery slope. I know plenty of primary care doctors and they all have families where the parents are skeptical, want to do certain things differently, etc. In most cases they try to do shared decision making and devise a plan that provides good care while still addressing parental concerns. Banning patients for disagreements over amount of TV time and broccoli in the diet is not a thing that happens.

I don’t know if banning families from the clinics is the right answer or if it is going to cause long term benefit or harm, but the point of this essay is basically to make sure you realize that while the doctors on the other side of this seem to be your enemy, there is true deep-down belief that they are doing what is best for not only YOUR child, but all the children in their care.

There is some more interesting back-and-forth on the thread. If you want to read the entire thread, including additional replies I have after what’s provide here, you can click on the link I provided at the top of this post, but as requested above, please just read and don’t enter the conversation.