Doctor refuses to treat the unvaccinated

[jive turkey]

Quote

An Alabama doctor announced he would not treat patients who refused to get vaccinated against COVID-19 ...

Alabama Doctor Refuses to Treat Unvaccinated COVID Patients

[jive turkey]

2 minutes ago, SmilingBluEyes said:

Well , you are right JT. A patient with whom a doctor has no relationship is not going to be discharged, clearly. But the only thing that needs to happen is for the physician to assist pt to find alternative places for an established patient to go, where the values/behaviors more line up with his/her practices.

I see nothing at all wrong with that. I don't blame this doctor for doing what he is doing. He is limiting his practice to patients who do not refuse to adhere to his recommendations for avoiding disease/death/permanent disability. Thus, reducing risk to himself for malpractice and for other patients not to get sick. Makes perfect sense to me.

If I missed something about this please share with me.  

I'm not understanding how vaccination for one particular disease is an ethical prerequisite for any kind of care within the doctors scope of practice.  Especially children.  The child did not get to decide to vaccinate.

"Little Timmy's throat is hurting and he's crying?  Did you vaccinate him? No? Get out.  Take little Timmy somewhere else."

Imagine if that caught on?  Now it's off to the ER where you can't be refuse.

[toomuchbaloney]

9 minutes ago, jive turkey said:

If I missed something about this please share with me.  

I'm not understanding how vaccination for one particular disease is an ethical prerequisite for any kind of care within the doctors scope of practice.  Especially children.  The child did not get to decide to vaccinate.

"Little Timmy's throat is hurting and he's crying?  Did you vaccinate him? No? Get out.  Take little Timmy somewhere else."

Imagine if that caught on?  Now it's off to the ER where you can't be refuse.

This presumes that the parent doesn't seek care at another practice.  That's an odd assumption unless it's based on some premise that the antivaxx parent might be irresponsible enough to just not seek another provider out for routine care.  

[SmilingBluEyes]

No I am sure if Little Timmy's throat is sore, and the parents have not vaccinated, the doctor would not immediately kick them out of his/her practice.

But if they persist in non-vaccination, despite medical advice otherwise, yes, then realistically, said doctor would not be wrong to assist them in finding another provider whose values and beliefs more match their own.

[GrumpyRN, NP]

4 hours ago, jive turkey said:

 Now it's off to the ER where you can't be refuse.

Except it is not an ER problem. So send them back to their own doctor. Oh dear, no doctor? Then too bad. Take responsibility for YOUR decisions for YOUR child. 

Remember I am not in US so any nonsense regulations you have do not apply.

[subee, MSN, CRNA]

4 hours ago, toomuchbaloney said:

This presumes that the parent doesn't seek care at another practice.  That's an odd assumption unless it's based on some premise that the antivaxx parent might be irresponsible enough to just not seek another provider out for routine care.  

 

4 hours ago, jive turkey said:

If I missed something about this please share with me.  

I'm not understanding how vaccination for one particular disease is an ethical prerequisite for any kind of care within the doctors scope of practice.  Especially children.  The child did not get to decide to vaccinate.

"Little Timmy's throat is hurting and he's crying?  Did you vaccinate him? No? Get out.  Take little Timmy somewhere else."

Imagine if that caught on?  Now it's off to the ER where you can't be refuse.

Oh,, more of your ridiculous overstated drama.  First, that kid wouldn't be coming in through the front door because of all the vax and mask signs up front. Remember, the doctor doesn't want them to even come to the office. I can't believe what a megillah I have to go through every simple time just to get into the PT check in, or worst, a dentist.  I'm sure a couple of liars have slipped in so it's not perfectly safe. 

[HarleyvQuinn, MSN, RN, NP]

11 hours ago, jive turkey said:

If I missed something about this please share with me.  

I'm not understanding how vaccination for one particular disease is an ethical prerequisite for any kind of care within the doctors scope of practice.  Especially children.  The child did not get to decide to vaccinate.

"Little Timmy's throat is hurting and he's crying?  Did you vaccinate him? No? Get out.  Take little Timmy somewhere else."

Imagine if that caught on?  Now it's off to the ER where you can't be refuse.

You're ignoring that the practice likely already had these rules in place, regarding all childhood scheduled vaccinations, so the child wouldn't be going to that practice to start with. They would be seeing a pediatrician at a practice that accepts patients who choose not to vaccinate. There are also free clinics and urgent care centers, or the ER for emergencies. If the practice does not have an established relationship with the patient, however, there is no liability. By choosing not to accept patients who do not accept vaccinations for highly contagious, vaccine-preventable illnesses, the practice can protect their other patients and staff in the office from exposure. Measles cases are popping up due to low vaccination rates in areas. Immunity to measles can actually wane over time from our initial MMR series as children, which is why some hospitals choose to obtain a titer for their staff on hire. There has been some discussion in research about a possible booster for MMR due to waning titers/immunity for some. Imagine being a pregnant nurse in a pediatrics clinic where you're exposed to measles by a patient whose parents have chosen not to vaccinate. 

 We also give Tdap instead of Td as a booster one time after the age of 11 years to boost immunity for pertussis. This is not done for the sake of the adult receiving the vaccine, as an infection with pertussis is going to be mild and unlikely to cause them problems. We give this booster to adults to provide added protection to the infant and toddler population by boosting immunity in the population as a whole to pertussis, as it carries much higher mortality for them. This very, very young population is another that is vulnerable and that pediatricians and family practice providers want to protect. That's why some have chosen, just as those patients have chosen to refuse vaccination, that they do not wish to accept them into the practice. Other practices continue to accept those who choose alternate vaccination schedules or who choose not to vaccinate. To them, it's important to ensure that everyone is receiving care, and they take other measures to protect everyone as best as they can in their waiting rooms. 

 The practice I worked for as an RN accepted everyone. We had divided waiting rooms - sick and well. With COVID, we scheduled potential COVID cases at specific times just before lunch or at the end of the day, the family was to remain in their car, entered through a back entrance, and the room had to be shut down for hours afterward for very specific cleaning. There were other protocols for managing other potentially contagious illnesses, but this didn't stop a probable case of TB from resulting in staff exposures, or that family waiting in the waiting room with others. 

I've been watching the situation amongst the public regarding mask mandates and distancing with interest. Did you know that flight attendants have seen a significant increase in violence towards them due to their mandatory masking rules on planes? One flight attendant literally had teeth knocked out by a passenger. Teachers have been attacked by parents because they chose to wear masks at school. I'm curious as to how you feel mandating masks will go over any differently in primary care practices amongst this population? Especially given more than one state governor's rulings strictly prohibiting mask mandates in various ways. Regarding practice policies, I've seen patients become aggressive or violent over well-known policies of having to reschedule for being late - significantly late - in excess of 20-30 minutes past their appointment time. Vaccines, masking, and the pandemic have a lot more people worked up with stronger emotion tied to it. 

[jive turkey]

26 minutes ago, HarleyvQuinn said:

 

1.You're ignoring that the practice likely already had these rules in place, regarding all childhood scheduled vaccinations,

2.There are also free clinics and urgent care centers, or the ER for emergencies.

 3.By choosing not to accept patients who do not accept vaccinations for highly contagious, vaccine-preventable illnesses, the practice can protect their other patients and staff in the office from exposure.

4.Imagine being a pregnant nurse in a pediatrics clinic where you're exposed to measles by a patient whose parents have chosen not to vaccinate. 

 5.The practice I worked for as an RN accepted everyone. We had divided waiting rooms - sick and well. 

6.One flight attendant literally had teeth knocked out by a passenger. Teachers have been attacked by parents because they chose to wear masks at school. I'm curious as to how you feel mandating masks will go over any differently in primary care practices amongst this population? 

I hear what you're saying, and thank you for replying.  Don't take the following with sarcasm or hostility:

1. The doctor this thread started with wasn't a pediatrician but reference was made to such doctors.  I think there's a difference between seeing the patient and making care decisions after vs outright refusing them all together from get go.

2&3. I know you don't mean to say this, but using the logic you offered about protecting others in the lobby, this is the net result of the statement: 

Since the private practice MD doesn't want his patients put at risk, go ahead and put the low income families at the free clinic, and everyone at the ER at risk with the unvaccinated child instead. 

4. Working in the facilities is an occupational hazard regardless.  It is the mother's decision what risks she would expose baby to working as a nurse.

5. That makes the absolute best sense right there and would be the more sensitive, inclusive solution to caring for people regardless if we are talking COVID or not.  This should be common practice everywhere anyway.

6. Off to jail with them.  Nobody deserves having their teeth knocked out for enforcing a mask policy.  

Imagine if doctors decided to stop treating diabetics, citing prescribing them insulin only enables them to continue making poor diet choices, eventually being a burden to the health care system.  Would we accept that?  Or are we picking on COVID because its mainstream and everybody is scared for themselves?

 

[guest1163268]

On 8/31/2021 at 1:37 AM, jive turkey said:

I respect and appreciate your perspective.  While I don't feel it's entirely wrong, in this situation, I call bull on those docs.  

And I call bull on people who condone it. 

The People most in need of the doc are the hesitant.  Imagine if the doc accepted a visit, sat down and had a thorough discussion with the unvax patient.  Not just telling them they're wrong, pointing to articles etc but actually taking time to get to know them, understand their background, their worries, fears, perceptions, sources of facts, show empathy, and establish trust.  But of course that would take too much time and often aren't paid by the minute.

There will still be those that refuse.  There will be those that will be receptive.  But if they can't get through the door, there's no relationship as you mentioned.  If anything if fuels contempt for the virus.  People are not only hesitant but going from hesitant to more resistant thanks to the attitudes of medical professionals and portrayals of the public by the media.  

"They can go to another doctor"

People don't realize how detrimental rejection and disdain is from a provider.  

So if the goal is to increase vaccination, it won't be accomplished by refusing to help people.  

THAT is actually selfish.   

What is selfish, are people who actually know that they are ignorant because they actually don't read, their views are frequently wrong, because they chose not to educate themselves and when they are in educated company can't follow the conversation, and are usually embarrassed by the educated company etc etc. But, they have a smart phone or tablet! 

These sort of people either through pathology like personality or mental disorder, and also because of ego, protect themselves by being obnoxious or aggressive etc. They isolate into their small groups like themselves and reinforce their perspectives. They are also very JUDGEMENTAL! Again, it's a defense mechanism, but I personally don't waste any time on such people BECAUSE just like in substance abuse d/is, they have to hit rock bottom! I also think that they DESERVE to be discriminated against! BECAUSE THEY ARE USUALLY, ENTITLED, AGGRESSIVE, OBNOXIOUS, IGNORANT AND JUDGEMENTAL ! 

Unfortunately, they also procreate, raising children infused and influenced by the behavior they see and very likely to, repeat the pattern! 

And you come to immigrants! 

They arrive here usually not even speaking the language, with little EDUCATION OR knowledge about the society, but they quietly forge ahead and produce amazing, polite children, who they push to be educated and ambitious! They are law abiding and follow the rules and make incredibly productive citizens! 

Now compare them to the SELFISH, ENTITLED, AGGRESSIVE, OBNOXIOUS, UNEDUCATED, IGNORANT, JUDGEMENTAL people you are championing! 

When they come up to your car begging for money, who are you likely to give to? The polite, respectful person with a bottle of water and a squeegee or the aggressive, disrespectful, entitled jerk, who wants to spit on your windshield and use his sleeve? 

[iNurs5, CNA]

JT sounded like my ex. LOL. Now, he found his ways here. I would refrain from debating with him. He actually just enjoy bickering. 

[iNurs5, CNA]

He felt the need to be right. ? 

[HarleyvQuinn, MSN, RN, NP]

14 hours ago, jive turkey said:

I hear what you're saying, and thank you for replying.  Don't take the following with sarcasm or hostility:

1. The doctor this thread started with wasn't a pediatrician but reference was made to such doctors.  I think there's a difference between seeing the patient and making care decisions after vs outright refusing them all together from get go.

2&3. I know you don't mean to say this, but using the logic you offered about protecting others in the lobby, this is the net result of the statement: 

Since the private practice MD doesn't want his patients put at risk, go ahead and put the low income families at the free clinic, and everyone at the ER at risk with the unvaccinated child instead. 

4. Working in the facilities is an occupational hazard regardless.  It is the mother's decision what risks she would expose baby to working as a nurse.

5. That makes the absolute best sense right there and would be the more sensitive, inclusive solution to caring for people regardless if we are talking COVID or not.  This should be common practice everywhere anyway.

6. Off to jail with them.  Nobody deserves having their teeth knocked out for enforcing a mask policy.  

Imagine if doctors decided to stop treating diabetics, citing prescribing them insulin only enables them to continue making poor diet choices, eventually being a burden to the health care system.  Would we accept that?  Or are we picking on COVID because its mainstream and everybody is scared for themselves?

 

I don't sense hostility at all. I actually enjoy the discussion, as I agree there is always room to discuss potential ethical concerns when it comes to these issues. There are a lot of practice issues that are occurring due to choices being made by outside influences causing hardship on providers currently. It's creating all sorts of ethical dilemmas. 

 One of those is the concern regarding patients who are not compliant with treatment regimens. Providers are in a position where they can be sanctioned by lowered reimbursement rates when their patients aren't meeting metrics goals such as A1C, BP, lipids, etc. This has led to the discussion and concern about practices choosing not to see patients who remain non-compliant with treatment regimens due to decreasing reimbursement for the practice. This also means that practices that serve mostly vulnerable, lower-income populations will be those who are hit the hardest with lowered rates of reimbursement. It ignores the social determinants of health and barriers to obtaining healthcare for our vulnerable populations. 

 It is important to remember that, currently, those who are not being accepted into some practices are those who choose not to accept vaccinations. No provider is actually declining to treat illnesses, which is what you are referencing regarding diabetics. There is a significant difference between primary prevention, which is what vaccinations are, and tertiary prevention, which involves treating and managing chronic diseases. 

 To be quite honest with you, the ER has a whole lot more resources available to it with regard to mitigating and managing a patient with a potentially contagious, vaccine-preventable illness, than a private practice does. Case in point - TB. I merely offered free clinics as an alternative for patients to seek care that meets their personal beliefs and choices. I, personally, feel frustrated that any vulnerable person anywhere has to worry about the risk of being potentially exposed to vaccine-preventable illnesses while seeking care or engaging in their daily lives. It saddens me. It saddens me that there is not the same amount of empathy for our pregnant workforce, many of whom do not have a choice to simply stop working while pregnant to protect their unborn child due to financial considerations, who risk exposure and potential harm. The U.S.'s labor laws are generally not favorable to employees, particularly those who are vulnerable, lower-income, or pregnant. Nurses are not given an option to choose a "less risky" position during their pregnancy to try and protect their unborn child. 

 In healthcare, those who commit assault and battery are not always awarded jail time for their deeds. Laws are actually stronger for workers in other occupations. 

Things are stressful right now for everyone. We're in the midst of a pandemic with cases rising again. I recognize acute stress reactions and post-traumatic stress from being in the military and working with the military and our veterans. Economic hardship, housing hardship, and natural disasters are only going to compound upon this. We are in serious need of not just physical, but mental and emotional healing. Unfortunately, our healthcare system is stretched very thin right now and there is always the worry that this virus could mutate beyond the reach of the current vaccine. We desperately need the ability to spend time educating patients on the science, safety, and importance of vaccination, masking, distancing, and hygiene practices, but the business aspect of healthcare is hamstringing us out of being capable of doing so. Administrators and businessmen and women run healthcare right now. Not clinicians. 

 As a side note, I can share a story that has had a significant impact on me. During my deployment to Iraq as an RN, a young Iraqi girl came into the care of our combat support hospital. You see, her family was struck by a car bomb while they were just trying to go about their daily lives. She had some minor shrapnel wounds but was spared any other injury because her father shielded her with his body from the blast, sacrificing himself for her. Upon meeting us, this curious girl's first words to us were, "Why don't you speak Arabic?" She was scared, of course, but attached herself to one of my staff. Due to the nature of her wounds, we needed to give her a Tdap vaccination to prevent the possibility of tetorifice. She had never received any vaccinations before in her life. I had the opportunity to provide this child with the first vaccination she would ever receive, which would protect her from potential sequelae from her injuries. Sure, she was upset with me, and indeed did glare at me for a full fifteen minutes after the injection, but she did forgive me. I'll also never forget her father and the condition that he was in when he arrived at our hospital, nor the sacrifice that he made for her. Her strength, resilience, and the vulnerability she faced in that war-torn country have had a profound impact on how I view the world, healthcare, and how I practice. 

[iNurs5, CNA]

15 hours ago, HarleyvQuinn said:

You're ignoring that the practice likely already had these rules in place, regarding all childhood scheduled vaccinations, so the child wouldn't be going to that practice to start with. They would be seeing a pediatrician at a practice that accepts patients who choose not to vaccinate. There are also free clinics and urgent care centers, or the ER for emergencies. If the practice does not have an established relationship with the patient, however, there is no liability. By choosing not to accept patients who do not accept vaccinations for highly contagious, vaccine-preventable illnesses, the practice can protect their other patients and staff in the office from exposure. Measles cases are popping up due to low vaccination rates in areas. Immunity to measles can actually wane over time from our initial MMR series as children, which is why some hospitals choose to obtain a titer for their staff on hire. There has been some discussion in research about a possible booster for MMR due to waning titers/immunity for some. Imagine being a pregnant nurse in a pediatrics clinic where you're exposed to measles by a patient whose parents have chosen not to vaccinate. 

 We also give Tdap instead of Td as a booster one time after the age of 11 years to boost immunity for pertussis. This is not done for the sake of the adult receiving the vaccine, as an infection with pertussis is going to be mild and unlikely to cause them problems. We give this booster to adults to provide added protection to the infant and toddler population by boosting immunity in the population as a whole to pertussis, as it carries much higher mortality for them. This very, very young population is another that is vulnerable and that pediatricians and family practice providers want to protect. That's why some have chosen, just as those patients have chosen to refuse vaccination, that they do not wish to accept them into the practice. Other practices continue to accept those who choose alternate vaccination schedules or who choose not to vaccinate. To them, it's important to ensure that everyone is receiving care, and they take other measures to protect everyone as best as they can in their waiting rooms. 

 The practice I worked for as an RN accepted everyone. We had divided waiting rooms - sick and well. With COVID, we scheduled potential COVID cases at specific times just before lunch or at the end of the day, the family was to remain in their car, entered through a back entrance, and the room had to be shut down for hours afterward for very specific cleaning. There were other protocols for managing other potentially contagious illnesses, but this didn't stop a probable case of TB from resulting in staff exposures, or that family waiting in the waiting room with others. 

I've been watching the situation amongst the public regarding mask mandates and distancing with interest. Did you know that flight attendants have seen a significant increase in violence towards them due to their mandatory masking rules on planes? One flight attendant literally had teeth knocked out by a passenger. Teachers have been attacked by parents because they chose to wear masks at school. I'm curious as to how you feel mandating masks will go over any differently in primary care practices amongst this population? Especially given more than one state governor's rulings strictly prohibiting mask mandates in various ways. Regarding practice policies, I've seen patients become aggressive or violent over well-known policies of having to reschedule for being late - significantly late - in excess of 20-30 minutes past their appointment time. Vaccines, masking, and the pandemic have a lot more people worked up with stronger emotion tied to it. 

I declined for the MMR titer. I jumped for another series of MMR shots recently.