It’s getting harder and harder to accept the fact that some families are opting not to fully vaccinate their children. Five to 10 years ago when the controversies surrounding vaccination were at their height, I felt strongly that vaccines were both safe and effective, but I had little head-to-head data to prove that fact. Most of the data looked only at vaccinated children and didn’t compare them to unvaccinated children to assess outcomes.
During the time of huge controversy, several studies were already underway and others were begun to determine if vaccines were associated with any adverse health outcomes including autism, asthma, allergies, learning disabilities, or other developmental issues.
Now more than 30 studies have been published to address these issues and not a single one supports the notion that vaccines are a health risk, and given the clear benefit of preventing illness that at times can be life-altering, forgoing vaccination seems like a risky endeavor.
What I struggle with now is how to negotiate the relationship I have with my families who are opting out of some or all vaccines. I am a big believer that as a healthcare provider my duty is to give information and advice to empower families to take control of their lives in ways that encourage good health. I am not always going to agree with the decisions my patients make, however.
Examples of other ways in which parents make decisions I can’t support include the fact that some families will continue to offer their children juice even though they are overweight, or refuse to allow their child to cry in order to learn to sleep through the night. Some families will continue to permit late bedtimes despite the fact that their children are overtired. Some families will seek medication for illnesses where antibiotics won’t help. Some families will forgo well visits for their older children instead getting a sports physical at an urgent care facility when this is hardly adequate. Some families will refuse screening blood tests for lead poisoning or anemia. Some will fail to make appointments with specialists when needed while others will demand specialty care or tests that aren’t needed.
I have not refused to see these patients in my office or asked them to leave the practice. Some practices, though, have begun refusing to see families who won’t vaccinate their children fully and as a result there’s a group of “medically homeless” families looking for a place to have their children’s needs met. There are several distinct groups within the mass of families who are skeptical or anxious about vaccination and to lump them all into the same category is naive.
The smallest group among the vaccine-skeptics are the vehement non-vaccinators. This group has such strong anti-vaccination convictions that no matter what traditional medicine says, they cannot be swayed. Interestingly, these families often have given a tremendous amount of thought to many aspects of parenting and have strongly held opinions about everything from the foods they choose for their children to media exposure to the books their children read, and in many instances I agree with them about these other things.
Sometimes, though, the vehement non-vaccinators reject much of traditional medicine making it difficult to have a cooperative relationship. Some seek out chiropractic or homeopathic care for young children in lieu of seeking care from us when the utility of these alternative approaches has been studied and they are not beneficial. In addition, non-vaccinating families are more likely to refuse testing for contagious illness or refuse to follow any advice given about diet or sleep and yet call for help with illness management. When these parents are frustrated by their child’s behavior and seek advice over and over but the strategies that have been suggested are not attempted, we too get frustrated.
To be fair, though, some families who fully vaccinate are equally frustrating in this way but when we feel that the lack of willingness to follow advice is coupled with the choice not to vaccinate, it often makes us wonder what the family is looking for from a traditional medical practice.
Another sub-group of non-vaccinators are anxious parents who have heard a lot of hubbub over vaccines in the media but who also understand that the illnesses vaccines prevent are serious and vaccines work. Parents like this have often done their own investigating and will almost always be relying on information that is outdated and now shown to be invalid either from the Internet or Dr. Sears Vaccine Book. These parents often pick and choose which vaccines they want to give at various ages and will often listen and adjust if they are made aware of the current data and/or real risk of illness. They usually need a lot of reassurance and confident support from their healthcare provider to take the leap and vaccinate. They will sometimes forgo certain vaccines altogether despite our attempts to educate about the benefits.
The last sub-group of parents are those who are anxious about vaccinating but haven’t done much investigating. These parents have vague worries that stem from co-workers or friends talking about vaccine risks and a concern that they aren’t educated enough to make a good choice so are often reluctant to vaccinate. This sub-group is often receptive to hearing about the data that reassures about vaccine safety and will often ask whether my children are vaccinated. These families often ultimately choose to vaccinate.
I feel strongly as a healthcare provider that no family should accept what I suggest without questioning it. We all rely on the experts in our lives to give us guidance but in the end, if we don’t agree or don’t feel that the expert has our best interests at heart, it’s difficult to just go with the advice. The basis of the provider-patient relationship is trust and the best way to build that trusting relationship is to listen to the patient. If the person feels that he or she is truly heard and concerns are addressed and not dismissed, the relationship can grow and flourish. By listening to families’ concerns and world views, we can craft a plan that is much more likely to be implemented.
My overall assessment that all children should receive all vaccines doesn’t change based on a given family’s set of concerns, but by listening and really hearing them, we can have an honest dialogue. I may or may not be able to convince them that their child is better off with a full complement of vaccines, but by listening to them and acknowledging their concerns while addressing them, a sense of real compassion is communicated. I believe for many parents the decision to vaccinate is a difficult one, but if they feel that I understand how hard it is, over time they may choose to trust my advice and vaccinate their children.
Practices that won’t accept families who from the get-go aren’t ready to sign on to the whole set of vaccinations are missing an opportunity to be true physicians and teach. I have found that many families over time are receptive to vaccination and as our reciprocal understanding and respect for each other grows, the window for vaccination opens. Of course, there are some parents for whom the window doesn’t exist, but I still feel it is my responsibility to continue to discuss the risks of going without vaccination for their children and the other children theirs come in contact with.
For families who reject most aspects of traditional medicine, finding a different medical provider makes sense. But if a family is willing to discuss and listen to to what I have to say about the value of vaccination and give it real consideration, I feel that continuing the dialogue is in the child’s best interest.