How Providers Address Vaccine Hesitant Parents
Apr 10, 2013

Today Dr. Lara Zibners addresses an inquiry from our Facebook page that pertains to provider policies on vaccine refusal.  If you have a vaccine related question that you would like us to address, please email info@vaccinateyourfamily.org or send us a message on our Vaccinate Your Family Facebook page.

 

“I am finding an increasing number of new patients whose parents are refusing vaccination. As I am not the medical police, I give my best advice, but continue to accept these patients into my practice. There will always be parents who are dubious about the safety of vaccinations. Any thoughts from MD’s about how you deal with patients who choose to not vaccinate their children?”

Ah, this is a tough one. As doctors we never know what may come through the front door – the vaccinated, the under-vaccinated or the non-vaccinated— yet we do our best to deal with the situation at hand. As a mother, I willfully steer my own children clear of play-dates where I know the other child is likely unvaccinated. But the question is, once stepping back into my white coat and sensible heels, what should we do?

Some pediatricians have chosen to not allow families that refuse to vaccinate into their practices. And I completely understand their reasoning. Vaccine refusal puts the unvaccinated child and others at risk.  And this is a deeply emotional issue for many of us, isn’t it? We spend years and years training, and then dedicate our entire lives to the health and well-being of children. And I mean entire. I know a pediatrician who grocery shops at 11pm just to avoid the “Hi Doc! By the way, while we’re standing in the cereal aisle, would you mind taking a peek at Johnny’s left elbow…” Not that we don’t love our patients and their families, but this career does have a way of taking over your days, nights, weekends and occasionally even your choice of mayonnaise.

When you’re as invested as the pediatricians I’m proud to know, it’s difficult not to take vaccine refusal personally since this can mean that our patient’s family is openly disagreeing with our medical advice. Especially when we know their reasoning is often based on fear and misperception, rather than fact and science. And anyone who has tried to counter these misbeliefs (as I do) can quickly become frustrated (as I have). Parents who refuse to vaccinate are often so deeply committed to their decision that reversing their reasoning may seem exhausting, if not impossible.

Plenty of physicians feel strongly that their first commitment has to be to the health of all the children in their practice, so it’s understandable that some may decide not to see patients who refuse vaccination. After all, how can you ask a family, who willingly takes your advice, to sit in your waiting room with their infant child – who is not yet old enough for her first set of shots – alongside a whooping and unvaccinated two year-old with a florid case of pertussis? So maybe a separate waiting room for the vulnerable and another for the unvaccinated is the way to go if you have the space.

But as for refusing immunizations outright, that two year-old didn’t make the decision to not vaccinate. So doesn’t he also deserve the same excellent care as the rest of the children in your practice? That is the basis of the American Academy of Pediatrics (AAP) position: avoid discharging patients from your practice solely for a refusal to vaccinate. So good for you for stepping forward and offering a safe medical home to the families that question vaccines, as well as those who readily immunize.

But that doesn’t really answer your question, does it? The AAP believes that every visit with a family is an opportunity to readdress the issue of immunization and continue to educate and correct misconceptions about vaccine safety and efficacy. It’s entirely possible that a family will eventually make the decision to vaccinate.

A few other tips are:

• Try discussing each vaccine separately. Usually there are 1 or 2 vaccines that a family is specifically concerned about. Addressing their concerns about those particular vaccines may allow for some—if not all—of the recommended vaccines to be accepted.
• Address concerns about multiple shots in one visit, including steps your practice takes toward pain control and observation of potential reactions.
• Don’t be afraid to ask if cost is a factor. Some parents may be overwhelmed at the thought of yet another co-payment,or may have concerns unrelated to safety or efficacy, so be sure to identify their reasons for refusal.
• Just keep at it. Keep communication open as you work toward building a relationship of trust and respect.

Some physicians have also opted to have parents sign a vaccine refusal information form, similar to the recently approved California consent. This ensures that parents review printed information provided by credible resources and allows an opportunity for you to address any questions they have as a result.  In the time between visits, maybe new questions arose, or some of the information presented will have changed a parents’ ability to properly research and reconsider their initial concerns.

Research has shown that health care providers are the most important influence on a parent’s final decision on immunization.  Therefore, it’s important to establish ongoing, non-confrontational dialogue when dealing with vaccine-hesitant parents. Evidence-based data can be used to address the specific fears and concerns of parents and should be presented using parent-friendly literature and references to credible online resources that explain the value of vaccination.  The AAP and CDC are aware of the challenges that we face and are doing what they can to help those health care providers who are struggling with this very issue.  Here are a few resources that are designed to help:

• The CDC’s Provider Resources for Conversations With Parents (www.cdc.gov/vaccines/hcp/patient-ed/conversations/index.html)
• AAP’s Collection of Resources to Help Communicate with Families About Vaccines (www2.aap.org/immunization/pediatricians/communicating.html)
• Common Misconceptions About Vaccinations and How to Respond to Them (www.cdc.gov/vaccines/vac-gen/6mishome.html)
• Vaccine-Related Journal Articles that Explore How to Communicate to Parents (www.immunize.org/journalarticles/comm_talk.asp)
• How to Communicate With Vaccine-Hesitant Parents (http://pediatrics.aappublications.org/content/127/Supplement_1/S127.full)
• Sample Vaccine Policy Statement (www.immunize.org/catg.d/p2067.pdf)

After all, the only way we are going to persuade those who are vaccine hesitant is by calmly leading them to the facts: vaccines are safe and effective. And to lead by example. My own children—including my middle-aged husband—are fully vaccinated. As a professional, I will continue to promote vaccination and educate others to the best of my ability. And I will take my hat off to those of you who assume the awesome responsibility for the general pediatric care of the children of this world. Children who may one day encounter my own.

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