I recently read a story about pediatricians that refuse to see children when their parents’ decline vaccines.
It was the doctoring aspect of this story that caught my attention. Specifically, I was struck by the definitive and novel way that this group of doctors are dealing with the problem of patients that make unwise personal health choices–or in this case, the parents’ of the patient.
Their strategy?
They simple fire them. It’s the doctor’s way or the highway.
Here’s Seattle pediatrician, Dr David Dyer,
“I think more physicians need to be more aggressive about vaccinating kids. If you’re not willing to vaccinate your kids, if you’re not willing to trust us and trust our judgment and education, then we have a philosophical difference here,” he said.
Dr. Dyer says he has turned away families and encourages other doctors to do the same.
As a cardiologist, that strategy made me laugh.
Poor lifestyle choices are the chief cause of heart disease. Heart doctors struggle to find ways to convince patients to make better lifestyle choices. We urge them to eat less, exercise more, and not to smoke. But when they don’t do these things, we still squish their blockages, burn their rogue electrical circuits and implant lifesaving devices.
Even when patients do really dumb things, like over-indulge in alcohol, we still shock their “Holiday Hearts” back to regular rhythm.
It seems the epidemic of patients-making-unwise-health-choices has now spread to the world of childrens’ health. This is a new problem for pediatricians, for if left alone, kids default to living healthy. They eat when hungry, exercise play as a matter of routine, and they go to sleep when it’s bedtime. They don’t drink gin and tonics either. I often counsel my AF patients to live as a child would.
So what do I say to doctors who fire patients that make unwise health choices?
That’s weak!
Welcome to my world.
JMM
h/t to Dr. Wendy Sue Swanson, aka @SeattleMamaDoc
10 replies on “The doctor’s way, or the…”
Speaking as the parent of a child with an egg allergy and asthma, who for several years was unable to receive a flu vaccine, I can say I would prefer to take him to a pediatrician’s office where I knew I could rely on herd immunity in the waiting room. This may not be the best solution to parents who do not vaccinate their children, but this poor health decision doesn’t only impact their own child, but other children as well. These doctors don’t just have a “philosophical difference,” they are acting to protect the other patients under their care who could be harmed by this poor lifestyle choice.
Libby,
My response to your comment is two-fold.
First, I do not want anyone to mistake my point in the post. I am a science-based doctor, and believe strongly in the value of childhood vaccines. Not only that, but I also believe that vaccines promise to eradicate many more diseases in the future. My disagreement is with the strategy of dealing with parents’ of patients who refuse vaccines.
Second, I get the public safety argument. That doesn’t past muster in my mind. The elevator to the waiting room of my office (of nine cardiologists) opens to an expanse of tightly spaced chairs. Once one walks in there is no turning back, two steps off the elevator means you are exposed to the respiratory droplets of others. In the winter, many are coughing, sneezing and some have failed to follow their doctors’ influenza flu vaccine schedule. On the severity of infection scale, one could argue that exposing an older heart patient to influenza equals the danger of exposing a child to measles. (Again, I am not arguing against the rightness of vaccines; I advise heart patients to get the flu shot, whether it has traces of thimerosal or not.) But our group doesn’t place a sign on the elevator saying that you are not welcome unless you have had a flu shot.
What;s more, on the public safety argument, vaccines are only one (of many) means that unwise health choices endanger fellow mankind. Would these doctors also fire parents who smoke, feed their children high-fructose corn syrup, or text while driving? Those behaviors endanger children greatly.
My point is that kid-doctors–like all doctors– should have in their ‘bag of tricks’ the ability to persuade vaccine doubters. Sure, doing so is tiresome and frustrating. Success will require varied approaches depending on the background of the family. You can’t approach a non-adherent CEO the same way you approach a farmer. This piece from KevinMD suggests that many parents change their mind when presented the data. Alas.
Firing the patient–under the guise of public safety–because they don’t fit into the neat little boxes and schedules you like is a weak strategy.
Vaccines–like other beneficial therapies–improve the lives of people. When the science backs our treatments, doctors ought to be more successful in convincing patients than the Jenny McCarthy’s of the world.
Finally, in America, the notion of forcing people to take medicine is doomed to fail. That’s a good thing in my mind.
JMM
My child can’t infect your child with Hepatitis B, or Genital Warts, yet there are doctors who say even with these questionable vaccines. it’s their way or the highway.
The problem with the vaccine schedule is that among those vaccines, and diseases kids are not really at risk for.
If there’s no benefit to a vaccine, then any risk, however low, is unacceptible.
Vaccines, like any medical treatment, have risks. No treatment is risk free. But the obvious notion with common childhood vaccines are that their benefits far outweigh the risks. Moreover, another powerful way to consider the issue is that the risk of not-taking the vaccine is far-greater than taking it.
There are many other examples in medicine. Take statin drugs for instance. Here’s a group of medicines that have overwhelmingly decreased the cardiac event rates of patients with heart disease. In my mind, they are the most important medicine a patient with blood vessel disease should take. But yet, despite all their benefits, the infinitely small chance of severe liver problems gets amplified in the vastness of media and many patients simply refuse them. Patients need doctors to explain such basic facts of science and statistics.
Doctors have to be educators, not just technicians and checklist followers.
I used to think that my skills with an ablation catheter helped patients the most, but now I
believeknow my skills as a teacher help them far more.I’m a parent that had both children vaccinated. I was ignorant and did not inform myself. I did not realize the real consequences that could have happened. Yes the pamphlets told me of the minuscule chance. But years later I saw the effects that some suffered from side affects of vaccines.
We as patients make the mistake of treating our doctors as gods, as all knowing. But these pediatricians seem to be saying they know best. When in fact they have no right to make the decisions for children that are not theirs. I have a real problem with doctors refusing treatment.
Happy to be healthy at the moment
I wished I had a nickel for every time I said to a patient that I wasn’t a 100% sure…
As a pediatrician and a travel medicine doctor I spend my professional life counseling people about vaccines. I am in favor of vaccinations but recognize that individuals want to make their own decisions. In my opinion, physicians advise and counsel patients/families, not dictate care. We are available to help people make informed decisions and treat conditions. Patients come to us with a problem which we help them solve as best as possible, given the particulars of the situation. Let’s remember we are in a healing profession not a policing profession. But let us also be clear, that vaccines are effective. Engaging in meaningful conversation with our patients helps them understand their choices. Antagonistic relationships make it difficult for either party to hear what the other is saying.
Thanks.
Hello Dr. John,
Getting back to your original point: the trend towards firing patients…
As frustrating as it must be to continue to “squish their blockages, burn their rogue electrical circuits and implant lifesaving devices” in patients who insist on making poor lifestyle choices, one wonders why doctors like the pediatricians you mentioned don’t promote the wisdom of firing incalcitrant patients to all other specialties.
For example, a few years ago, the Journal of Medical Ethics ran an interesting observation by Dr. Søren Holm of Cardiff Law School about a U.K. entity called NICE, the ‘National Insitutute for Health and Clinical Excellence’ and its controversial dilemma at the time: whether health care resources should be invested in those whose conditions were considered to be self-inflicted. Example: patients on NHS liver transplant waiting lists were being taken off the lists if they refused to quit drinking. Dr. Holm argued:
“Participating in a number of sports and leisure pursuits, even at amateur levels, increases your risk of sustaining significant ankle or knee ligament damage, requiring surgical reconstruction. This is also true of alpine skiing, squash playing, soccer, and many other sports. If NICE takes its own principle seriously, we should expect guidance to orthopaedic surgeons that they are only to reconstruct sports-induced ligament injuries if the patient promises never to play that sport again.â€
Just think – if they fire non-vaccinating parents today, they’ll have to fire bike-racing physicians tomorrow!
More on this at: “Heart Attack: Did You Bring This On Yourself?” – http://myheartsisters.org/2009/11/14/bring-this-on-yourself/
Cheers,
C.
Interesting analogy. It’s true, my orthopedist threatens to fire me often.