Sunday, May 8, 2016

Immunizations Are About Trust and Science: My Alternative Vaccine Schedule




I am going to confess that I am my children’s pediatrician.  I have given them every vaccination they have ever had and probably would not trust another provider to do it.   I endorse the vaccination schedule recommended by the American Academy of Pediatrics; I believe it is safe and prevents disease.  I completed medical school and three years of pediatric training that helped shape this belief.  I have seen death in children from polio, whooping cough, and pneumococcal meningitis. 

However, I have chosen to use an alternative vaccination schedule when my vaccine-hesitant families request it.  Mine evolved over time to complete most of the required vaccinations by the time a child is 2 years old.  It is not “evidence-based”, the catchphrase we use to say something is scientifically proven safe and effective.  However, it is rooted in something I value highly as a pediatrician – trust, open communication, and compromise. 

My patients and I have a difference of opinion sometimes, whether it is about immunizations, antibiotics, or discipline.  That does not mean we cannot or should not keep talking to each other.  There are a lot of people out there not vaccinating their children, who may be putting others at risk of contracting disease.  Guess what?  They love their children as much as I love mine and you love yours.  As a pediatrician, I am going to trust you are doing what you think is best for your children, even if I do not agree with your opinion.

Physicians think that convincing parents to vaccinate their children is mostly about science.  I am going to argue discussing and deciding whether to vaccinate your child is more about trust for some parents than science.  Anytime we recommend treatment or perform a procedure, we are supposed to discuss the risks, benefits and, alternatives.  Somehow, primary care physicians are not supposed venture off the immunization schedule recommended by the AAP and CDC and discuss alternatives.   I am not sure how or why we boxed ourselves into this corner.  It does not leave much room for compromise.

We are talking about someone who is hesitant to hand over their 2 month old, 2 year old, or 10 year old for an immunization.  They have never seen diphtheria, tetanus, rubella, or measles.  They may never have held the hand of a child dying from preventable infectious disease.  Are we so far divided from these parents, we are unable to step back and see where they are coming from?

When I first went into practice, I accepted every non-vaccinating patient who walked through my door.  After practicing for 15 years in my hometown, I have learned there are two types on non-vaccinating families.  Those who want to build a trusting relationship with their primary care physician but are uncomfortable or hesitant to vaccinate.  They are always willing to hear me out and vice versa.  We have trust and rapport.  Some parents eventually do vaccinate and some do not, the point is we keep discussing it.  

Then there are non-vaccinating families who want to talk AT me and never WITH me.  Their brows furrow at the mention of vaccinations and their arms cross.  They call my office beforehand to remind me they do not want to discuss the subject at all during a well child exam.  It causes them too much distress.  I feel those individuals are not interested in a trusting relationship with me, involving give and take conversation.  There is nothing I can offer them.  So about 5 years ago, I stopped accepting non-vaccinating families into my practice unless I am able to figure out if they are interested in building a trusting relationship with me first.   

Some parents trust movie stars who oppose immunizations more than they trust their family doctor or pediatrician.  I know that is hard for a health care provider to accept, but it is true.  Times have changed and people do not look only to physicians for answers like they used to, nor should they.  Maybe there are things we, in primary care, could do better.  Maybe we could stop shoving science down parents’ throats and try a spoonful of compassion and communication to the help the medicine go down.

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