Is it Common for Doctors to Dismiss Patients Who Refuse Vaccines?
Nov 02, 2015

A new study published in Pediatrics examines the characteristics of doctors who dismiss families for refusing vaccines for their children.

While almost all of the 534 pediatricians and family physicians who were surveyed for the study have encountered parents who refuse vaccines, the survey also indicated that vaccine refusal is generally rare. Overall, 83% of doctors reported that 1% or fewer parents refuse one or more infant vaccines in a typical month.

When that happens, 21% of pediatricians and 4% of family physicians said they “always” or “often” dismiss these families, and 51% reported “always” or “often” requiring parents to sign a form if they refused.  However, there were some doctors who estimated that vaccine refusal in their practices were  between 1% to 4% of parents they encountered and some saying as many as 5% of parents they saw refused vaccines.

Although the survey was conducted in 2012, it has been published in a year when people are increasingly frustrated by recurring outbreaks of vaccine preventable diseases.  For instance, following the well publicized measles outbreaks that occurred in Disneyland late last year, there has been a surge of public support for strong immunization policies that favor vaccination for school children, daycare workers and healthcare employees.  This swell of public support has often been discussed as the catalyst for the record number of new legislative bills that were introduced this year in an attempt to reduce school vaccine exemptions and boost childhood vaccination rates in various states across the country.  While there is a general consensus that more needs to be done to educate parents about the benefits of vaccines, the question of whether doctors should refuse patients who decline vaccines is an ongoing debate that has drawn a great deal of commendation and criticism.

Both the American Academy of Pediatrics (AAP) and the CDC discourage physicians from refusing to see patients who refuse vaccines.  Instead, they have tried to urge physicians to continue to treat these children in hopes that an ongoing relationship with these parents will help build the kind of trust that may eventually lead them to reconsider their vaccination choices for their children.

Meanwhile, doctors who refuse unvaccinated patients have various reasons for doing so.

1. There is a concern for the health and wellbeing of other patients in the practice and the desire to limit exposing others to a potential risk of disease in the waiting room or examination room.
2. Many physicians feel that if parents don’t value their recommendations on something as important as vaccines, than they’re probably going to have difficulty establishing a trusting relationship on other health matters.
3. By threatening to drop a family from the practice for vaccine refusal, physicians can send a very strong message about the value of vaccines.
4. They want to protect themselves from liability and disease.

While this study has helped characterize doctors who dismiss vaccine refusing families (such as being more likely to be in private practice, or from a state without a philosophical exemption law), what it does not reveal is the impact of such policies.

Are we alienating these families and causing hardship for them in seeking routine medical care for their children?  Are they heading off to visit alternative healthcare providers instead?  Are we essentially creating a niche market for providers who are willing to forego vaccine recommendations, or worst yet, reassure families that skipping vaccines is nothing to worry about?  

In her Forbes article, What Kind of Doctor Fires Vaccine-Refusing Patients? Tara Haelle explains that the authors of the Pediatrics study raised an important hypothesis

“that dismissing families could lead to increased clustering of vaccine-refusing families within certain regions, leading to outbreaks of vaccine-preventable diseases.”

However, their own results suggest that lower vaccination rates and higher rates of vaccine-preventable diseases tend to be in states in which physicians are less likely to dismiss families.  Instead, they suggest their findings promote the idea that

“having a policy for dismissing families may actually increase vaccine uptake, as it provides a strong message to families on the importance of vaccination.”

Unfortunately, there will need to be more research to get a better understanding of how these policies are impacting vaccine uptake. It would also be interesting to better understand whether disease outbreaks and stronger immunization policies are helping to influence physicians’ decisions on whether to dismiss patients who refuse vaccines.

To read more commentary on this topic, check out a few other Shot of Prevention blog posts and current news stories:

Should Doctors Refuse Patients Who Refuse?

Doctors Take a Stand For Immunizations

How Providers Address Vaccine Hesitant Parents

What Kind of Doctor Fires Vaccine-Refusing Patients?

One in Five Pediatricians Drops Families Who Refuse Vaccines: Survey

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