Should Doctors “Fire” Vaccine Refusers? A Physician’s Point of View

A recent Wall Street Journal article suggested that more physicians are becoming comfortable with the idea of “firing” their patients who refuse vaccines.  Most do so because they are concerned about the spread of contagious diseases in their offices to infants and children too young or too ill to be protected with vaccines.

We thought the issue of how doctors work with families who have concerns about vaccines to be an important one affecting both pediatricians and patients,” said Shirley Wang, author of the  Wall Street Journal article. “The issue also raises broader questions about what doctors’ responsibilities are to patients.”

Dr. Melanie Mouzoon

Dr. Melanie Mouzoon is the Managing Physician of Immunization Practices and Travel Medicine at Kelsey-Seybold Clinic in Houston.  In this entry she explains what she believes, regarding vaccinations, to be her responsibilities to her patients and the community as well.

A Physician’s Point of View

When word gets around that a pediatrician is comfortable with families who refuse vaccines, are selective about which ones they will administer, or want to follow an untested schedule, that practice attracts many similar families.  Just as there are schools with high percentages of unimmunized children, there are pediatricians’ offices with the same problem.  In this situation, not only do pediatricians wind up spending more time discussing vaccine safety in an attempt to convince families to protect their children, they also have to worry about outbreaks of measles, pertussis and meningitis in their offices.

Other doctors feel that the trust, which is necessary in the physician-patient relationship, has deteriorated over time as discussions with families about the need for and safety of vaccines has become protracted and the refusers more entrenched and resentful.

Every pediatrician I know spends lots of time answering questions and concerns that parents have about their children.  Vaccines are not an exception to this rule.  As physicians, we see parent education as a part of our job.

When parents refuse vaccines, we do our best to determine what their fears are, what their experiences have been and where they are getting their information.  We respond with science-based information and honest answers and we do it visit after visit after visit, if they remain unconvinced.

We work with parents to accept at least some of the recommended vaccines, if not all.  We space out vaccines even though we know that this needlessly delays their protection. We discuss known risks of infection versus perceived and actual risks of vaccination. Despite this, some families won’t protect their children with vaccines.

Everyone knows that you need to change your car’s oil every so often.  You might follow your car’s scheduled maintenance guide or you might choose to stretch out service a little longer than recommended. However, eventually, you need to change the oil or your engine won’t perform as well.

If you went to your mechanic for other maintenance, but steadfastly refused to have the oil changed, he would do everything he could to convince you – up to a point. Eventually he has to choose either to keep you as a client (perhaps he can make more money fixing your engine rather than changing your oil) or tell you to find a mechanic whose advice you trust.  At least this scenario doesn’t involve risk to anyone else’s car!

I continue to advocate for vaccinations with families, because I care about their kids.  If they choose to leave my practice because I am adamant about ensuring their child gets vaccinated, so be it. I fully understand why some physicians would ask some families to seek care elsewhere.  If you don’t trust my advice regarding vaccines, why should you trust me with your medical care?

Dr. Melanie Mouzoon is certified by the American Board of Pediatrics and her expertise has been called on by local newspapers, radio and television stations.



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