"Should Doctors Fire Their Anti-Vaccine Patients?"

Published

"Perhaps in frustration, doctors have started to "fire" their patients if they refuse to vaccinate. As reported by Shirley Wang in The Wall St. Journal last week, 20-30% of doctors in two different surveys, in Connecticut and the Midwest, reported having to kick patients out of their practices because of vaccine refusal. These numbers have roughly doubled over the past ten years, according to the American Academy of Pediatrics."

http://www.forbes.com/sites/stevensalzberg/2012/02/25/should-doctors-fire-anti-vaccine/

Specializes in FNP, ONP.

HEDIS and Meaningful Use requirements, as well as certain insurance reimbursement agreements require that we meet performance standards for a variety of measures, including immunizations, colonoscopy, mammogram, A1C, lipids, blood pressure, and many others. Weight/BMI is not yet on the list. Yes, we are punished financially for failiing to meet benchmarks; so yes, we are incentivized to sever relationships with patients who are non-compliant with the POC. This is one of many reasons why "pay for performance" is a very bad idea, indeed. In the end, the concept harms patients.

I support parents rights to immunize at their own pace, but if I am going to be fined for doing so, I'll have to ask them to keep to the CDC schedule or go elsewhere. I'm not going to pay out of my pocket for their cold feet. Nor am I going to pay out of my pocket for Debbie Donut lover to maintain an A1C of 13. Debbie is going to either get with the program or find a new provider. I am as empathetic as the day is long until Debbie starts taking proverbial donuts out of my kids' college funds. At that point, she is on her own. And she can just schedule the bloody mammogram and colonoscopy and get it over with already. I am sure as hell not paying out of my own pocket because she is too lazy to get it done. That WILL cost me money, and I am not down with that. If she wants to decline those things, she is going to have to see someone that is not participating in HEDIS and/or Meaningful Use campaigns (i.e. someone without an EMR) and someone that isn't participating in one of the capitated "advantage" plans.

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Yes, doctors should fire their antivaccine patients. I do not want to be taken care of by an idiot. If doctor fires me for refusing flu vaccine I will know he/she is an idiot. Well, in fact I am in my 40's never go to a doctor, even do not have a PCP. Several years ago I had flu with temp 39.5 -40.3 C. Did not go to a doctor, did not take meds. My job is to give meds to stupid patients. It is not my job to poison myself with such garbage as tamiflu which is no better than placebo. Temp of 40 C is not fun but it does not kill either. temp of 42 C kills but it never goes that high with infection. You can die of fever if you fever is r/t heat stroke or poisoning. In this case brain loses control over body temp and it reaches 42. Not typical scenario with flu. Sorry for too much information for RN's brain.

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Specializes in Adult Internal Medicine.

My job is to give meds to stupid patients.

Sorry for too much information for RN's brain.

Are you an NP Steve? I am a tad concerned about your line if thinking there.

As for the OP, it should be every provider's right to dismiss a patient from their care for any reason they choose. I think refusing vaccines is an acceptable reason in specific patient populations.

I don't dismiss a patient for being obese. I do dismiss patients if they break CS contracts, fail to show up for appointments, etc. Our practice is now considering dismissing patients that refuse to have lab work done that their insurance requires for reimbursement.

It's every patient's right to fire a provider for "being an idiot" too.

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Specializes in Anesthesia.
Yes, doctors should fire their antivaccine patients. I do not want to be taken care of by an idiot. If doctor fires me for refusing flu vaccine I will know he/she is an idiot. Well, in fact I am in my 40's never go to a doctor, even do not have a PCP. Several years ago I had flu with temp 39.5 -40.3 C. Did not go to a doctor, did not take meds. My job is to give meds to stupid patients. It is not my job to poison myself with such garbage as tamiflu which is no better than placebo. Temp of 40 C is not fun but it does not kill either. temp of 42 C kills but it never goes that high with infection. You can die of fever if you fever is r/t heat stroke or poisoning. In this case brain loses control over body temp and it reaches 42. Not typical scenario with flu. Sorry for too much information for RN's brain.

1. You did not go to a PCP and you self diagnosed yourself with influenza. That means you have no lab studies to say whether you had influenza or another viral illness which signs and symptoms are often very similar.

2. Research does not agree with you on the use of Tamiflu/neuarminidase inhibitors (one of the literature reviews is posted below).

3. Your job is to give meds to stupid patients? Does that mean in your perspective only stupid people take medications?

4. Do you have any peer-reviewed scientific research to back up your claims or is everyone an "idiot" and/or "stupid" that doesn't agree with your unfounded ideologies?

Impact of neuraminidase inhibitor treatment on outcomes of public health importance during the 2009-10 influenza A(H1N1) pandemic: a systematic review and meta-analysis in hospitalized patients

+Author Affiliations

  • 1Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, UK
  • 2Division of Epidemiology and Public Health, University of Nottingham, UK

  • Correspondence: Jonathan Van-Tam, DM, FFPH, Room A40d, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, United Kingdom ([email protected]).


    [*=left]↵* Dr Muthuri and Dr Myles wish to be named as Joint First Authors

Abstract

Background. The impact of neuraminidase inhibitors (NAI) treatment on clinical outcomes of public health importance during the 2009-10 pandemic has not been firmly established.Methods. We conducted a systematic review and meta-analysis, searching 11 databases (2009 through April 2012) for relevant studies. We used standard methodology conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using random effects models.Results. Regarding mortality we observed a non-significant reduction associated with NAI treatment (at any time) vs none (OR, 0.72 [95% CI, 0.51 - 1.01]). However we observed significant reductions for early treatment (≤48h after symptom onset) vs late (OR, 0.38 [95% CI, 0.27 - 0.53]); and for early treatment vs none (OR, 0.35 [95% CI, 0.18 - 0.71]). NAI treatment (at any time) vs none was associated with an elevated risk of severe outcome (OR, 1.76 [95% CI, 1.22 - 2.54]); but early treatment vs. late reduced the likelihood (OR, 0.41 [95% CI, 0.30 - 0.56]).Conclusions. During the 2009-10 influenza A(H1N1) pandemic, early initiation of NAI treatment reduced the likelihood of severe outcomes compared with late or no treatment.

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Specializes in Case Management, ICU, Telemetry.

I am a strong believer in independent acquisition of liberty... If doctors want to fire their patients for not immunizing- they have that right. I absolutely DO NOT blame them for not wanting to pay out of their pocket for someone else's decisions- rightness or wrongness is irrelevant. If a physician doesn't want to treat a patient for ANY reason- they have that right. Equally- Parents have the right to vaccinate or not vaccinate. They have a right to choose a physician, any physician that fulfills their needs. Neither is doing "wrong" or "right", whether they "should" or "shouldn't" is an entirely individual decision.

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Specializes in Anesthesia.
I am a strong believer in independent acquisition of liberty... If doctors want to fire their patients for not immunizing- they have that right. I absolutely DO NOT blame them for not wanting to pay out of their pocket for someone else's decisions- rightness or wrongness is irrelevant. If a physician doesn't want to treat a patient for ANY reason- they have that right. Equally- Parents have the right to vaccinate or not vaccinate. They have a right to choose a physician, any physician that fulfills their needs. Neither is doing "wrong" or "right", whether they "should" or "shouldn't" is an entirely individual decision.

I absolutely do not believe a parent has a right to not vaccinate their children unless they will never set foot in public for the rest of their lives. Someone's right to liberty ends when it interferes with my children's and my family's health.

Unvaccinated people are a risk to themselves and the general public. This is proven over and over each year with vaccine preventable outbreaks. I for one do not want unvaccinated children around my children.

Medical providers have a duty to treat patients, but if a patient will not abide by the medical providers recommendations then there is no reason to continue to try and treat them. Every healthcare provider has treated patients that they do not like at one point or another, but that isn't the point. It is the expenditure of time, effort, and lost revenue that could be better spent helping compliant patients that matters.

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Specializes in ER.

I tend toward libertarian views. I absolutely support the right of parents and patients to make their own vaccine choices. I absolutely support the right of doctors to fire any patient for any reason.

As far as fearing unvaccinated people, I argue that that is the purpose of vaccines. Get the vaccine to protect yourself from the disease and worry about the unvaccinated. Problem solved and individual liberties respected!

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Specializes in Anesthesia.
I tend toward libertarian views. I absolutely support the right of parents and patients to make their own vaccine choices. I absolutely support the right of doctors to fire any patient for any reason.

As far as fearing unvaccinated people, I argue that that is the purpose of vaccines. Get the vaccine to protect yourself from the disease and worry about the unvaccinated. Problem solved and individual liberties respected!

And that means you absolutely do not understand how vaccinations work. How Do We Know That Herd Immunity Exists? » The Vaccine Times

Personal liberties stop when it interferes with public health and well-being.

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And that means you absolutely do not understand how vaccinations work. How Do We Know That Herd Immunity Exists? » The Vaccine Times

Personal liberties stop when it interferes with public health and well-being.

Thank you!! I am so TIRED of the comment of "just vaccinate yourself and you should be fine if they work". Some don't understand how vaccines work. If I was an MD I wouldn't keep families that do not vaccinate (unless of course they cannot due to allergy or immunologic issues). They put the rest of your patients & their families, your staff, and yourself at risk.

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Specializes in LTC.

I recently had a baby and have spent way too much time on parenting message boards. When the topic of pediatrician shopping comes up one of the questions I see being asked my parents is, "do you take care of unvaccinated children?" Some parents are looking for pediatricians who require their patients to be vaccinated they don't want their kids in the office waiting room with unvaccinated kids.

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"Nobody makes money off basic vaccines"

That has to be the most naive thing I have read yet..... Do you think the pharmaceutical companies manufacture drugs out of the kindness of their heart? News Flash: Drug Reps. have been banned from reputable medical offices because their persuasion tactics are considered unethical. Do you think that these reps. really care about the well being of you, personally? Or do you think the free lunch the office gets, and the bonus the side gets take precedent?

That surgeon took an oath to take care of his patients to the best of abilities, not to judge them for their decisions. ...

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Specializes in Adult Internal Medicine.
"Nobody makes money off basic vaccines" That has to be the most naive thing I have read yet..... Do you think the pharmaceutical companies manufacture drugs out of the kindness of their heart? News Flash: Drug Reps. have been banned from reputable medical offices because their persuasion tactics are considered unethical. Do you think that these reps. really care about the well being of you personally? Or do you think the free lunch the office gets, and the bonus the side gets take precedent?[/quote']

The profit margin for pharmaceutical companies on vaccines is much smaller than the profit margin on medications; many refuse to make vaccines for the reason. That is what that statement refers to I suspect.

Have you had many interactions with drug reps? Not to defend them but the days of the free vacations are long gone; now they actually provide some useful services for patients.

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