Are doctors being asked to practice substandard care?
Jul 13, 2010

By Christine Vara
I’m a parent, not a doctor.  But often times I’ve wished I had gone to medical school.  Maybe then I could diagnose my children’s ailments without having to wait for an appointment.  Maybe then I could understand all the complex medical jargon I come across when trying to educate myself in regards to various health concerns.  But then again, maybe I would just rather not.
There was a time when I envied doctors, but not anymore.  When I think of all that doctors need to know these days and all the complications of insurance, malpractice and so on, I am no longer envious. 
Take for instance the many different opinions people have in regards to vaccinations.  Personally, I am convinced that vaccines are an effective way to prevent, and in some instance, almost eliminate, certain diseases.  I vaccinate myself and my children to protect us from these diseases.  I feel a sense of duty to help protect others as well through the concept of herd immunity.  However, there are plenty of parents who may not agree with me.  Some would question whether the vaccines are safe.  Some argue that they are not very effective.  Some are concerned about the number of vaccines recommended these days.  While others question whether there is even a need.
Unfortunately, doctors these days often represent the “front line” in the vaccine debate.  They are typically the ones who come face to face with the parents and their often pre-conceived opinions.  I’m not saying parents shouldn’t have a healthy skepticism in regards to the medical advice they are given, but I do think that it is important that a doctor and their patients develop a special relationship of trust between them. 
For instance, I would venture to say that most people want to trust that their doctor is familiar with the scientific data in regards to vaccine safety and effectiveness.  They need to trust that their doctors are committed to providing the best care possible. 
On the flip side, a doctor should also be able to trust that their patients will consider their advice and honor their expertise.  Given these considerations, it is easy to see how a lack of trust and mutual respect can interfere with the doctor/patient relationship.  
In hearing from Dr. Paul Offit, in his article entitled, “Dealing With Parents Who Want to Delay, Withhold, or Space Out Vaccinations,” I understood the challenges that face doctors these days.  (Read the article by creating a free account on Medscape.) When parents decide to delay or withhold vaccinations, doctors are often faced with a moral and professional dilemma. They may be confident in their own recommendations, but if those recommendations, and those of the CDC and AAP, are not considered by their patients, they are knowingly offering substandard care.  Do they turn them away, or hope that in keeping these patients in their practice that they can eventually persuade them to consider the benefits of vaccinating on time?  Let us know your opinions on this.  We want to hear from doctors, as well as parents and patients.  What is a doctor to do?  What do you think is most effective?  
Below is a synopsis of the article reference above.  Log onto Medscape to create a free account and read it in it’s entirety.

Dealing With Parents Who Want to Delay, Withhold, or Space Out Vaccinations” Medscape (July 7, 2010)“…What I thought I would talk about today is something I think has become a growing problem for pediatricians and family practitioners alike, which is what to do with parents who are choosing to delay, withhold, separate, or space out vaccines for their children… On the one hand, a physician could say, ‘okay, I’m going to try the best I can to give these children as many vaccines as I can give them,’ realizing that for some children, there may be a significant delay in a vaccine, a delay which can only increase their chance of getting a vaccine-preventable disease… I think that when the CDC and the AAP recommend vaccines that they know are safe and effective and they know that can prevent disease, and a parent says, ‘I don’t want to do it that way,’ you’re being asked to practice substandard care, which could result in harm. In the Philadelphia area, we’ve had — in the past year — 3 children who died of Haemophilus influenzae type B meningitis. They died because their parents were more frightened of the vaccine than the disease it prevented… Probably the best comparison that I can give is that it would be like someone coming in and saying, ‘I don’t want to use a car seat for my under 4-year-old child. I want to hold my child in the car; could you just tell me the best way to hold them?'” – Dr. Paul Offit”


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