Recently the vaccine conversation has been hot and heavy both in the media and in my office. Most recently the question of whether or not a pediatrician should keep unvaccinated children in their practice has been debated. In my practice, I never turn anyone away. Per the American Academy of Pediatrics recommendations, pediatricians should still be able to provide excellent care to unvaccinated children while also continuing the conversation about the importance of vaccinating. The way I see it, my unvaccinated or vaccine hesitant patients fall into 3 categories. The bulk of this post is for #3.
#1 Children who can not get vaccines for legitimate medical reasons or parents who are concerned about vaccine reactions in their older children.
#2 Vaccine hesitant families who see me right after the birth of their child with many questions and concerns. These are families in which the conversation starts early. I answer their questions with honest, scientific answers in a caring and diplomatic way. Many of these questions and answers can be found at my blog post here. These conversations build trust and many of these families will vaccinate either on schedule or on a delayed schedule. While I agree that a delayed schedule leaves children vulnerable to disease, my part of the informed consent equation is providing the “information”. It is up to the parents to make the ultimate decision and as long as they understand the risks and we work in a partnership, I support them.
#3 Families who come in as new patients that are already unvaccinated after hopefully having the discussion with their previous doctor. These are the families that this post is directed at. These are the families in which the parent’s body language and short answers tell me their minds are made up and they don’t want to talk about it anymore. This can be very uncomfortable for the first visit with a family so in order to get through a 20 minute physical I tend to drop the issue. I don’t like confrontation, I want to build a relationship with them and I don’t think taking the entire visit to discuss vaccination will change their minds. I offer to answer any questions they have and move on. They will still be given stellar pediatric care and for the most part they seem to appreciate all of my other advice. However, there are some things I need for them to know. Here it goes:
Dear Parents of XYZ,
Thank you so much for trusting me to be your partner in the care of your child. I have been to 4 years of medical school, 3 years of pediatric residency, have over 10 years of experience in practice and I am a mom too. For more information on my background, please see my blog post Becoming a Doctor. I feel that this more than qualifies me to help guide you through parenthood. Together, we will get through growth, development, sleep issues, behavior, potty training, picky eating and even the occasional illness. One of the most important things I will do is advise you on ways to keep your child safe and protected. The mainstay of preventative medicine in pediatrics is vaccination. Since you have already decided not to vaccinate, I need to let you know what my concerns are. Please keep in mind that I have your child’s best interests at heart and no matter what your choice, I will be here for you.
- I worry that your child will come down with a serious life threatening disease.
- I worry that your child will infect a vulnerable child that is unable or too young to be vaccinated either in my waiting room or out in the community.
- I worry that this will affect our relationship as it becomes the elephant in the room. I have to bring it up at every well visit whether you want me to or not.
- I worry that if you don’t trust me on this important issue, are you still trusting my other advice?
- I worry that your choice was based on false or unscientific information.
Please let me know if you have any questions about my concerns or vaccines in general. I hope we can continue the conversation and build a lasting relationship. I want to watch your family grow and be there for you in any way I can.