Side-note– which is to say, a hijack, but I think important: my GP cousin, who has always disallowed not-fully-vaccinated children (with exceptions for allergies, living with a cancer patient, etc) from his practice, is still requiring that children in his practice get the “old list.” He has also decided that adults in his practice need DTP every 10 years, and yearly flu and COVID, by way of keeping his waiting-room safe. Don’t agree, and you can find another doctor.
Given what other doctors sometimes require of patients– signing a pledge not to drink or do drugs before receiving certain prescriptions, or needing yearly physicals with bloodwork, he’s not far out.
FTR, he also makes people get yearly physicals and bloodwork, but gives an office visit discount to everyone who complies promptly. I forget exactly what the parameters are, but he doesn’t disinvite people from the practice until a physical is like, 2 years overdue. The discount is for people who make the appointment within 15 months of the last one. (IIRC)
Actually there are several interrelated issues buried there. First is the fact that he is surviving as a stand alone doc! They still exist but it is a challenging place to be.
As to the refusing to take on families that are not willing to do all or in some cases any of the vaccines you recommend - he may be an extreme point in that he requires compliance with every vaccine he recommends, but more and more practices won’t accept vaccine refusers in general.
For years I was on the other side of the argument (and let’s be clear, the waiting room safety argument is specious, the risk much more to the community at large) - having had for years the experience that we could developed the relationship with these families that they often came around, something less likely to happen if we refused to engage.
My position has shifted, mainly because today’s refusers are no longer reachable, or so rarely that it isn’t worth the effort. But our company claims our specific contracts with our payers doesn’t allow us to refuse to care for these patients. I can encourage them to find another practice but not dismiss them based on that alone. (I think it is bullshit.) Mind you occasionally when discussing vaccines a refuser parent can cross a behavior line that allows dismissal, and I have.
Really? I feel like the most dangerous place i ever go (in terms of infectious disease) is the waiting room at my PCP’s office. Or maybe the waiting room at urgent care. I would have thought vaccinations would reduce that risk a bit.
Although i do see, maybe in some other thread, that when Japan reduced the vaccinations required for children, including annual flu shots, most of the excess deaths that followed were among the elderly. Still, i bet a lot of those elderly picked up flu from a family member who’d caught it at a pediatric waiting room.
Yes really. Let’s focus on kids first - the exposure in a waiting room is not even a rounding error of their exposure to each other during the crest of life. Even adults - most offices’ waiting rooms are not so crowded that people have to be on top of each other or waiting very long. The rest of life, stores, religious services, dancing, movies, much more.
There are only a few highly infectious enough vaccine preventable diseases to be concerned about in that brief exposure - measles and chickenpox really.
Exactly right with kids, flu, and the elderly - getting kids vaccinated helps protect the elderly not from exposure in waiting rooms but in the rest of the world. Kids were not very effective spreaders of Covid but they are of influenza.
In my experience, they are moderately crowded, I’m stuck there for a while, and several of the other people there are visibly ill. Sick people don’t usually go out dancing. We explicitly ask them to stay home, in fact, and they generally do. But sick people go to the doctor. The stores i go to are much less crowded, and i don’t spend nearly as much time next to any other person, than my doctor’s waiting room.
Religious services and movies are crowded. Often more crowded than medical waiting rooms. But i guess they aren’t part of my daily life. I maybe go to a movie theater once a year. I went to a more more religious services before covid, but okay, they, like medical appointments, are a place i wear a mask to even when the respiratory disease rate is low locally.
But last summer, before my husband was diagnosed with cancer, the only places i was wearing a mask were religious services, dances, doctors offices, and pharmacies. I’d stopped wearing a mask anyplace else.
Let’s first discuss the pediatric vaccine preventable diseases that this sort of discussion is usually focused around - even pertussis is not so contagious that we are going to worry about a waiting room exposure. Much more worried about grandma with mild symptoms exposing the newborn. Pneumococcal exposure, H flu, hep B, even rota … not waiting room level. Measles and chickenpox risk to those too young to already be vaccinated yes. Talking half hour wait though. Then reported 13% risk. That sort of wait happens commonly in EDs. Hardly ever in our office at least, and I don’t think we are special.
Okay flu. Sad thing vaccinated or not a fair number will still get it. MUCH less likely to get seriously ill vaccinated but still infectious. But if both they and you are masked, and better yet you are also vaccinated yourself, that waiting room exposure is low risk.
People staying home when they are sick is fine. But people are contagious with influenza at least a day before symptoms.
Not that you need to arbitrarily add more rice to your diet, but if you, or anyone else reading this thread, want to branch out:
Rice is not limited to white and brown - there are black and red varieties that are far more nutritious than white and even brown (higher in fiber and containing various flavonoids). And they are MUCH tastier, in my opinion, than brown rice, which is my least favorite kind of rice.
Red rice can be kind of dry, so one option is to mix 1/3 to 1/2 red rice with jasmine or other long-grain rice before cooking.
Black rice comes in several varieties, some of which are stickier than others, but it’s quite flavorful.
My husband cooked with black rice, and also red rice, for a while. It has a very strong flavor. It’s tasty, but doesn’t go with everything. Using it instead of white rice is like using kasha instead of white rice. It was also tricky to source.
He didn’t use it for health reasons, just to expand our repertoire. Maybe we should try it again.
Black rice is traditionally called “forbidden rice” because in ancient China it was forbidden to eat it unless you were royalty. It is actually more of a dark purple color and there are varieties grown in America. FWIW it and red rice have similar cooking tine and volume requirements as brown rice and all three can be freely mixed together.
This is where I’m always concerned about Yelp and Google reviews.
By being a good but hard-assed doctor, he’s liable to get bad reviews. You get another doctor who will let you have anything to want or demand, and he’ll get stellar ratings.
In a small town, maybe you don’t have a choice who your doctor is but, once there’s an option, customer reviews have the power to really screw with community health levels.
I wouldn’t be surprised if the opioid epidemic was, effectively, just the real world manifestation of this.
We love some of our negative reviews! They are often the ones complaining that we are so constantly on them about vaccines when they’ve already told us they don’t want them.
PLEASE shout those negative reviews loudly! Encourage the refusers to find a less annoying practice than us! Let the sane folk know how hard we are trying …