Childhool Vaccine Refusal

  1. For those of us who provide primary care to kids, what are your thoughts on this survey of physicians? The survey discusses physician thoughts about refusing vaccines. I'd agree with the statistics about numbers refusing and/or delaying vaccines, but I was shocked by some of the following.

    -- 40 percent of physicians always or often require parents to sign a form if they refuse a vaccination. Most physicians would agree to spread out vaccines in the primary series at least sometimes.

    -- Approximately 10 percent of physicians would often or always dismiss families from their practice if they refuse vaccines in the primary series and another 5 percent would sometimes do.

    -- About one-third of physicians say the vaccine discussions were negatively affecting their job satisfaction.

    My office doesn't require a refusal form, but our EHR has a checklist of things we discuss if parents refuse and of course I make a note about info given, risks of not vaccinating and I even quote the parents reason for refusing. I'm not against a refusal form, but we just don't have them. I try to understand why the parents don't want vaccines and work from there, but I'm not judgmental about it if they ultimately decide do forgo a vaccine or all vaccines. We have a pretty big Mennonite and Amish population and most of my vaccine refusals come from this group, but since they had a few bad cases of measles in the communities in last couple of years, we have fewer refusing practice wide than in the past.

    Okay the second stat sort of surprised me. I understand the importance of vaccination, but I wouldn't think to dismiss a patient for this reason, but up to 15% of physicians are doing this. I know that with some of the populations, dismissal will only make them distrust ALL healthcare and to me, that would be counterproductive.

    I can't say vaccine discussions affect my job satisfaction. I guess that I don't become emotionally vested in the conversation. Heck, sometimes all I have to do is listen. Once they realize I'm not going to force them or be angry with them, or I'm going to allow them to space out the vaccines, they actually listen to what I say and decide to vaccinate. I think they come into the office thinking I'll be confrontational, because it's my job to be, and when I'm not they realize I am there to work with them. I can usually get SOME vaccines in MOST of my patients just by listening and actually HEARING what they're saying.

    Anyway, any thoughts? Do you dismiss patients for refusing vaccines? Do you HATE having this discussion with patients? Are you flexible with vaccine schedules?

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    About NPinWCH

    Joined: Jan '04; Posts: 377; Likes: 382
    NP-C; from US
    Specialty: 15 year(s) of experience in Family NP, OB Nursing