Sunday, May 8, 2016

Immunizations Are About Trust and Science: My Alternative Vaccine Schedule

I confess that I am my children’s pediatrician.  I have given them every vaccination they have ever had and probably would not trust another physician 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 believe in parent choice and do not believe in mandates when discussing healthcare.  Patients must have autonomy.  I 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 that deciding whether or not to vaccinate your child is also about trust.  Anytime we recommend treatment or perform a procedure, we are supposed to discuss the risks, benefits and, alternatives.  Why are primary care physicians not "allowed" to venture off the immunization schedule recommended by the AAP and CDC and at least, discuss alternatives?  We have boxed ourselves into a corner and not left 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, hesitant, or unwilling to vaccinate.  They always hear me out as I do them.  We have trust and rapport.  I may not agree with their decision, but I respect these parents.  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.  It seems those parents are not interested in a trusting relationship with me or anyone else with an MD after their name, and that is alright. If there is no space for give and take conversation, there is little else I can offer to them.  
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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