I *said *ha-ha.
The silver lining to threads like this one… I’ve read a few of them now, and related links, and I know more about vaccination than I did a few years ago. Our first kid is four and a half, and we got her all her vaccines on schedule, but yeah, a part of me was scared when she got the MMR. Even though I’d done enough research to know there wasn’t actually a link to autism, and we never considered *not *getting her the shot, the blizzard of scaremongering around it had had some effect on me.
Our second kid is almost ten months old and I’ll be hugely relieved when she’s old enough to get her MMR. Those of you fighting ignorance on this: thanks. The kid would’ve got her shots anyway, but you’ve made it less scary for me.
My sister-in-law is a pediatrician in a very wealthy neighborhood where lots of mothers obsess over vaccinating their babies. A few years ago, a baby within their practice died of whooping cough, despite the best care available. Now the practice will no longer accept as patients new parents who will not agree to vaccinate. Most end up agreeing, thankfully. I think all pediatricians should tell prospective parents that unless they’re willing to vaccinate, they’ll have to go somewhere else.
As a kid, I read a book called Cherry Ames: Mountaineer Nurse. Much of the plot dealt with her efforts to protect babies in the community who were too young for the pertussis (which the author calls whooping cough) vaccine from older children who hadn’t yet been vaccinated. She wound up drafting another nurse as a teacher and setting up a boarding school which you had to be vaccinated to attend. It’s very suspenseful, actually, but no one contracts pertussis.
Although one kid almost dies of appendicitis, so there’s that.
For a book written decades ago with a Nancy Drew-wannabe heroine, it’s got a pretty powerful message that a bunch of people could stand to hear today. One mother stands up at a community meeting and says that “Every child should have the needle.” The doctor tells Cherry Ames that six of her nine children had died of illnesses that vaccines would have prevented.
Which was, incidentally, the inspiration for Agatha Christie’s The Mirror Crack’d From Side To Side
Here’s one who’s made that decision and explains why.
*"I have no doubt that these (antivax) parents love their children immensely and are making what they believe to be the best decisions for them. I don’t dispute that. But any potential partnership we might create in caring for them together would rely on their belief that I have something other than a signature on an order form or prescription pad to offer.
They must believe I have a perspective worth understanding.
I often wonder why a parent who believes vaccines are harmful would want to bring their children to a medical doctor at all. After all, for immunizations to be as malign as their detractors claim, my colleagues and I would have to be staggeringly incompetent, negligent or malicious to keep administering them.
If vaccines caused the harms Jenny McCarthy and her ilk claim they do, then my persistence in giving them must say something horrifying about me. Why would you then want to bring your children to me when you’re worried about their illnesses? As a parent myself, I wouldn’t trust my children’s care to someone I secretly thought was a fool or a monster.
It’s not merely that I don’t want to have to worry that the two-week-old infant in my waiting room is getting exposed to a potentially-fatal case of pertussis if these parents bring their children in with a bad cough. It’s not just that I don’t want their kid to be the first case of epiglottitis I’ve ever seen in my career. Those are reasons enough, to be sure. But they’re not all.
What breaks the deal is that I would never truly believe that these parents trust me. Giving kids vaccines is the absolute, unambiguous standard of care, as easy an answer as I will ever be able to offer."*
Well, then the unvaccinated kids would get no medical care at all - and I doubt it would knock any sense into the hardcore conspiracy nuts.
They’ll probably go to another ped. Which I think is for the best for them. As Jackmanii’s link sums up that makes sense. What kind of person wants a ped who they think is literally trying to poison their children?
Which kind of sums up the utter crazy of the anti-vax people. They literally believe that nearly all doctors, the WHO, pretty much every single government and every single scientist is engaged in a conspiracy to deliberately hurt their children with vaccines. It’s a depth of irrational thinking that must make it nearly impossible to communicate with someone.
Dr. Sears, a well known ped who likes to pretend he’s not particularly anti-vax even though he really is, has responded by creating his own bullshit vaccine schedule. His schedule is not grounded in science at all.
So what exactly do you do with them? I personally think you make it as hard as possible for the crazies. Exemptions should be hard to get and medically based. Parents should be told to either vaccinate or homeschool. Medical professionals should be firmly told to get a damned flu vax or wear a mask half the year.
The herd can take a few hits. The key IMO is to make those hits as few as possible.
I strongly disagree with the cop out of refusing to care for the kids whose parents are vaccine refusers/delayers.
Kids deserve good quality care even if their parents are misguided. If those of us who are competent physicians all refused to care for them they will then get all their care from quacks with who knows what harms done?
Or they will pile up in the offices of those of us who do not refuse to care for them, dumping them and the extra work dealing with them represents on us, the other peds.
Short version, in my experience at least half, if not three forths, of the vaccine refusers come round. After a few visits they develop some trust of me over the Playboy bunny. Yeah they often still want to do one at a time and are delayed, but I can get the most important ones in and at least provide some modicum of protection, which is more than they would have gotten if they went to whatever quack validated their irrationality. Slightly less of a chance of them catching something and exposing everyone else. And they trust me on everything else to the same degree the other parents in my practice do. That pediatrician’s fears are unfounded and ungrounded, a rationalization made not out of principle but because he is too lazy to make the effort of developing the trust over time and persisting at making the sale. So he dumps it on those of us who will still try. He is cherry picking and abdicating his responsibility.
Just my view from the trenches.
If a parent thinks vaccination isn’t merely useless but the cornerstone of a sinister conspiracy, I’m not sure a pediatrician who endorses vaccination can give their child quality care without the parent being an obstacle.
I appreciate your perspective; it illustrates once again how complex this whole stupid situation is. There really is no good solution to force parents to do the right thing, for their children and the community as a whole. We do nothing, and innocents suffer. We do some things, and the law of unintended consequences starts to come into play.
I was a member of a strongly anti-vaxx community, although I’ve come around to become staunchly pro-vaxx myself, and lost not a few friendships over it. In my experience, there’s about 30 seconds between “The doctor dropped me from his practice because I won’t let them vaccinate,” and “So, like I’ve always said, those doctors don’t know shit, always on some crazy power trip! I breastfeed and eat organic and so what the hell do we need with a doctor anyway?” Then the next time the kid sees a doctor is in the Emergency Room.
In other words, if an anti-vaxx parent is dropped from a practice, it’s highly likely they will *not *go to another, at least in the crunchy-granola alt med subculture. I can’t speak to the overeducated West Coast housewife subgroup.
Obviously I am not in the pediatrics “trenches”, but in addition to providing care for children placed in a bad situation by their parents, there is also the consideration of risk to oneself, one’s employees and all the other kids seen by the practice who may come into contact with unvaccinated, infected children.
Here’s the experience of a pediatrician who also continues to see unvaccinated children as patients. During his medical training he was exposed to measles while caring for an AIDS patient who ultimately died of the disease:
“For the next 10 days I lay on my friend’s floor coughing uncontrollably, hallucinating, dehydrated, with fever spikes to 105 degrees. In retrospect, I know that I had pneumonia and encephalitis, dangerous complications of measles infection. I have never been sicker in my life, and I could easily have died. I had also potentially infected a lot of people during my tour of the children’s hospital when I was at my most contagious point in the illness. The Department of Health had to be called in to trace my steps and try to protect all of my potential contacts. I, and anyone I may have infected, was a victim of the 1989-1991 US measles epidemic.”
This doc is almost certainly now immune to measles. However, I would not view it as a “cop-out” if someone in his position refused to subject others in his practice to the same experience that befell him.
I really appreciate DSeid’s sharing of his perspective on this issue. My problem is many of these vaccine-preventable diseases are so horrible and so dangerous, especially for little kids, that when you don’t vax you really are creating potentially serious problems for babies who don’t deserve to be the victim of anti-vax nuttery.
DSeid, do you have a separate waiting for well baby visits? And what do you think of the possibility of literally creating a list of peds that can see such anti-vax patients? Should a parent like myself even have the right to know if a ped accepts anti-vax patients?
At under four months, my pediatrician would not keep infants in either the sick or well waiting room, period. You went straight back to the exam room. I very much appreciated this.
Jackmannii I think you recognize how poor of a tool anecdotes are to evaluate risk. The risk to me of becoming seriously ill from a vaccine preventable disease by virtue of exposure in my practice is near nil and statistically I am more likely to be exposed to it from an immunized patient than from an unimmunized patient (just so many more of them).
LavenderBlue, once upon a time we were able to keep the populations separate by doing sick in the mornings and well in the afternoon but that is no longer able to be rigidly held. Mostly we take the approach of running on time in general and in truth the risk of exposure to a child being held or in a carrier for 5 to 10 minutes (rarely much more) in a waiting room is extremely infintessimal.
I think the list idea would be a horrible one. Any parent can ask their doctor or doctor to be what their policy on the subject is and expect to get an honest answer though. Be careful of unintended consequences as well: what do you think would be the result of concentrating the relatively few vaccine refusers in few locations as opposed to spreading them out among all offices most of whom have the vast majority of patients and staff fully vaccinated?
I congratulate you if no one waits more than 5-10 minutes to see the doctor.
I suspect in that case the children of vaccine refusers would infect each other first, same as if they’re relatively concentrated in schools or day care centers that don’t enforce vaccination standards.
By the way, the “extremely infinitesimal” risk for the “vast majority of patients and staff” from unvaccinated kids climbs sharply for those who have immune deficiencies, diseases (or treatments) that cause immunosuppression, or infants for whom it is too early to provide immunization.
if I had a child (particularly in those categories) I wouldn’t want him/her to go to a pediatrician whose practice included non-vaccinated children.
I have vivid memories of my own case of measles as a child. No picnic.
My own priorities in a ped were a) strict vaccine advocacy, b) highly supportive of my efforts at nursing and c) office hours easy on a working woman such as Saturdays and later in the day. I was lucky to find a ped who met those criteria. She’s from India and launched into a huge spiel about the importance of vaccines when I first called her. I was very amused as she apparently assumed I was on the fence at least.
I think what might help is more education of pregnant woman on the importance of adult vaccines as well. I warned my parents “No flu shot / updated pertussis vax no going near the grandchild.” I think they made a doctor’s appointment about ten seconds after I said that. 
Jackmanni … that is “rarely” not never and that is for getting out of the waiting room and into a room. Still, yes we do pretty well, being more than 15 minutes off from appointment time does not happen too much, mostly pretty much on time. Our office manager runs a pretty efficient operation. The back up for people is often waiting in the room for the nurses to come in with the shots and we are still working on improving that.
Yup, they infect each other much more commonly as there is no herd in between them … then they go into the schools and public sphere and expose the herd, some of who catch it and spread it as well.
No, I do not think that it climbs sharply enough to get over infintessimal.