In any given month, the vast majority of physicians treating children in the US (93%) receive at least one request to delay child vaccination; many of them (37%) often or always honor the request, despite putting the kids at a needless risk for disease and favoring potential outbreaks of diseases such as measles.
Allison Kempe, MD, MPH, from Children’s Hospital Colorado in Aurora, and colleagues asked a nationally representative sample of 534 physicians if they ever receive requests from parents to delay vaccination. The Centers for Disease Control and Prevention advises that children be vaccinated for 14 diseases before age 6 on a schedule, which entails roughly 29 shots – sometimes several at once. If the vaccination is delayed then the child is still vulnerable to the disease, thus risking becoming sick and contributing to a potential outbreak.
“Our data demonstrate that primary care physicians are spending a good deal of time discussing vaccines when parents have concerns, that they are trying a variety of methods of handling requests to spread out the vaccine schedule, and that, in general, they find few methods to be effective in increasing timely vaccination,” the authors write. “Although they perceive that there are harms associated with spreading out vaccines, they usually agree to do so.”
This approach is coherent with the idea of treating patients like partners – giving them a say in the final decision, something encouraged (to some extent) by most doctors. However, this is an example where this can backfire.
“At some level, you’re ceding your expertise, and you want the patient to participate and make the decision,” said Dr. Paul A. Offit, a pediatrician specializing in infectious diseases at the Children’s Hospital of Philadelphia, who was not involved in the study.The downside is that “you have to be willing to stand back and watch them make a bad one. It is sad that we are willing to let children walk out of our offices vulnerable to potentially fatal infections,” he added. “There’s a fatigue here, and there’s a kind of learned helplessness.”
Unfortunately, this trend seems to be even rising – in 2009, a study found that 13% of physicians agreed to spread out vaccines. The current survey found that 37% of physicians do this often, which is highly worrying. It seems to be that there is some kind of fatigue or feeling of helplessness, but it seems that doctors need to get their act together and communicate to the patients the risk they are subjecting their children to.
In late February, Dr. Nivedita More, a pediatrician in Rancho Santa Margarita, Calif., sent letters ending her relationship to parents who refused all vaccinations.
“If they aren’t getting their act together to even start the process, I’ll discharge them within 30 days,” said Dr. More, a board member of the Orange County chapter of the pediatrics academy.