Home > In the News, Science & Research > Is it Common for Doctors to Dismiss Patients Who Refuse Vaccines?

Is it Common for Doctors to Dismiss Patients Who Refuse Vaccines?

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.

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Image by the “Refutations to Anti-Vaccine Memes” Facebook page.

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

  1. November 2, 2015 at 11:27 pm

    It is not common but more practices are doing it on the basis that endangering their other patients to accommodate a few patients is unethical. In a clinical setting where there are a number of alternatives including a “permissive” practice this can be justified. That the deniers identify a group of parents that are demanding, suspicious, uncooperative, non-compliant and frequently rude, I understand the few that do this.

    Like

  2. V. Boyd Alexander
    November 3, 2015 at 2:31 pm

    “That the deniers identify a group of parents that are demanding, suspicious, uncooperative, non-compliant and frequently rude, I understand the few that do this.”

    Don’t ask any questions, just follow orders. After all it is only your child.

    Like

  3. Lawrence
    November 3, 2015 at 2:57 pm

    There is big difference between asking questions and belligerently attacking pediatricians.

    Like

  4. V. Boyd Alexander
    November 3, 2015 at 3:08 pm

    Exactly

    Like

  5. November 4, 2015 at 12:29 am

    How safe are vaccines?

    What are the cons of requiring all children to be vaccinated?

    – Curious mother hoping someone can answer my questions. Thanks!

    Like

  6. Chris
    November 4, 2015 at 1:01 am

    “What are the cons of requiring all children to be vaccinated?”

    They get to go to school. They skip having high fevers, poxes, seizures, meningitis, hundred days of hacking coughs, reduced immune systems and increased probability of disability or death. Would that be a problem for you?

    Like

  7. Lawrence
    November 4, 2015 at 7:27 am

    Well, first – not all children will be vaccinated. There are always going to be a small percentage that cannot be vaccinated, for legitimate medical reasons.

    If everyone else, who can be, are vaccinated, it will protect those who cannot.

    The other con (but only if you love germs), is that certain diseases will be eradicated, like measles, for instance.

    Like

  8. Chris
    November 4, 2015 at 11:15 am

    “How safe are vaccines?”

    About a million times safer than the actual diseases.

    Like

  9. jgc56
    November 4, 2015 at 11:23 am

    “How safe are vaccines?”

    All evidence indicates being vaccinated is much, much safer–often by orders of magnitude– than remaining vulnerable to infection by the diseases they protect against.

    Consider the MMR vaccine as an example: one of the known adverse events associated with the vaccine is encephalopathy: the vaccine has been seen to cause 1 excess case of encephalopathy for every 1 million children vaccinated. Measles itself, on the other hand. is seen to cause 1 excess case of encephalopathy for every 1 thousand people infected.

    One case in a million versus one case in a thousand: with respect to encephalopathy the vaccine is 3 orders of magnitude safer than remaining vulnerable to infection.

    “What are the cons of requiring all children to be vaccinated?”

    I’m not aware that there are any, and I’ll note that there are no laws which require ALL children are not required to be vaccinated: those who of identifiable medical reasons are known not to be suitable candidates for vaccination can receive medical exemptions.

    There are of course cons to electing NOTto vaccinate, such as placing not only your own child at risk of serious infectious disease but also. by undermining herd immunity, placing third parties at increased risk of serious infectious disease.

    Like

  10. jgc56
    November 4, 2015 at 11:53 am

    “Don’t ask any questions, just follow orders. After all it is only your child.”

    Ask all the questions you wish to, V, but if you’re going reject the answers you receive for no rational reason what was the point in asking them in the first place?

    Like

  11. Larry
    November 4, 2015 at 5:28 pm

    Chris, is that your answer to the question “What are the cons of requiring all children to be vaccinated?”
    I think you may be confused.

    Like

  12. Larry
    November 4, 2015 at 5:31 pm

    V Boyd, I agree, you get labeled as a crazy parent just for asking a few questions. I’ve heard stories of Doctor’s going bizerk if you question them.

    Like

  13. Gray Falcon
    November 4, 2015 at 5:45 pm

    So, Larry, how much did you embezzle? Any anger or denial will be treated as admission of guilt.

    There’s a reason “just asking questions” is known as JAQing off.

    Like

  14. Chris
    November 4, 2015 at 5:58 pm

    Larry: “I think you may be confused.”

    No, I am not. It seems there are a group of people who think kids need to get sick and suffer from high fevers, seizures, and months of coughing so bad they vomit and turn blue. Making the rounds recently is a mom who is proud that all three of her kids got pertussis, and she did not do anything to prevent it and did not bother to get them real medical care.

    She actually thinks parents who prevent diseases are lazy:

    Madilyn had been coughing for 60+ days. We hadn’t slept longer than 2 hours in months. UGGGGGH. Sleep, it’s for the select few parents who probably drug their kids or lock them in their rooms.

    Of course she is wrong about “drug”, because vaccines prevent the illness, and therefore prevent things like antibiotics, steroids, artificial ventilators, etc.

    How about you tell what is so great about having kids get measles, mumps, pertussis, tetanus, Hib, rotavirus, chicken pox, influenza, etc. My kids are older, and got a couple of those things before the vaccine was available, and it was horrible. You need to work very hard to convince me that getting sick when it can be prevented is a good thing. Because I think parents like the one quoted above is a child hating sadist.

    Like

  15. Lawrence
    November 4, 2015 at 7:23 pm

    @Larry – what do you believe the “cons” are to vaccinating children?

    Like

  16. Larry
    November 5, 2015 at 6:16 pm

    Lawrence, the cons of vaccination are the risks of injury. Can you think of any more?

    Like

  17. Lawrence
    November 5, 2015 at 6:33 pm

    Since the risks of injury are so slight compared to the risks of the disease itself, it is merely a con if one cannot due the proper risk analysis.

    Like

  18. Larry
    November 5, 2015 at 6:38 pm

    You can’t get injured from a disease you don’t have.
    You can get injured from a vaccine you intentionally get. So the con is the risk to injury. The benefits of vaccination outweigh the cons, but please don’t compare risk of injury to a vaccine to a disease you don’t have.

    Like

  19. Lawrence
    November 5, 2015 at 7:08 pm

    Except when you get that disease because you aren’t vaccinated.

    Like

  20. jgc56
    November 5, 2015 at 9:34 pm

    “You can’t get injured from a disease you don’t have.”
    This is like arguing that because you can’t get injured by a car accident you aren’t having right now seat belts will not reduce your risk of injury in a car accident.

    The fact is you can get injured by a disease you don’t have now if at later point in time you do get that disease. Vaccination reduces the likelihood you will get the disease at a later time, reducing your risk of injury by that disease.

    “You can get injured from a vaccine you intentionally get.”
    Is the risk of being injured by a vaccine larger or smaller than the risks associated with remaining vulnerable to infection by the diseases they protect against?

    Like

  21. Larry
    November 6, 2015 at 5:27 pm

    If you want to compare the risk of vaccine injury to that of the disease, then you first have to factor in the odds of getting the disease and then the odds of becoming injured from the disease. You cannot compare vaccine injury to disease injury if you do not have the disease. You must factor the odds of getting the disease first and then factor the risk of injury from the disease.

    Like

  22. jgc56
    November 6, 2015 at 5:45 pm

    But i didn’t ask you to compare the risk of being injured by the vaccine to the risk of being injured by the disease though, did I? the question I asked was whether the risk of being injured by a vaccine was larger or smaller than the risks associated with remaining vulnerable to infection by the diseases it protects against?

    Infectious diseases prior to vaccination weren’t rare, after all. Consider chicken pox: prior to the introduction of a vaccine against varicella virtually every child in the US became infected– the annual incidence of infection was roughly equivalent to annual birth cohort. (http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html)

    Like

  23. Gray Falcon
    November 6, 2015 at 5:46 pm

    The odds of getting the disease depend highly on how many vaccinated people are in the area. If you’re the only one in an area who isn’t vaccinated, the odds are extremely low. If you’re one of several thousand who aren’t, the odds are much higher.

    Like

  24. Larry
    November 6, 2015 at 5:48 pm

    You didn’t ask me anything. I started the string with the cons of getting vaccinated are the risk of injury.

    Like

  25. Larry
    November 6, 2015 at 5:50 pm

    Is that the best you can do Gray? You can’t come up with an average % chance of catching measles?

    Like

  26. Larry
    November 6, 2015 at 5:50 pm

    Not sure why you guys are such a-holes???

    Like

  27. Gray Falcon
    November 6, 2015 at 5:58 pm

    Larry: No, I can’t. It’s not a constant, it’s a variable. But if the vaccine didn’t exist, it would be nearly 100%.

    And if everyone you interact with seems to be an a-hole, consider the common factor in all your interactions: you.

    Like

  28. jgc56
    November 6, 2015 at 6:06 pm

    ” I started the string with the cons of getting vaccinated are the risk of injury.”
    Offset acted by the fact a major pro of getting vaccinated is a much greater reduction in the risk of injury by the disease the vaccine protects against.

    Like

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