These are challenging times to be a pediatrician. To my knowledge, never in the history of Pediatrics has our profession been under this much suspicion from our patients’ families. Anti-vaccine rhetoric has an impact on the way that we all interact with patients, and it continues to challenge me as a provider on a daily basis.
I’m going to hold my commentary on the validity of vaccine research. That’s really not the point of this conversation, and we can probably going to that another time. What I’m talking about is the impact of anti-vaccine belief on your interaction with her child’s pediatrician. Here’s the thing – the vast majority of pediatricians believe that vaccines are necessary for the health of children. After educating ourselves, we still believe that vaccines are safe for almost every child and that vaccine exemptions should be limited to medically necessary situations. This conflicts with the beliefs of many parents, who have somehow gotten the idea that vaccines harm children and are unnecessary. The physician-parent-patient relationship is like any other, and this kind of conflict will cause problems.
The line of anti-vaccine reasoning gives us 2 options. Option a) we (the pediatricians) are paid by pharmaceutical companies to inject children with things that harm them and do it knowingly. Option b) we simply don’t know any better and have taken the word of the pharmaceutical companies in regard to vaccine safety without doing our own personal research. Now, I’m going to make a couple of assumptions. First, I would put forth that any doctor that knowingly injects babies with things that could harm them is evil. Second, any doctor who is unable to review medical literature and assess the value of the science is incompetent.
What does this have to do with me?
If anti-vaccine reasoning is right, any vaccine-supporting physician is either (a) evil or (b) incompetent. Now, I may or may not be evil or incompetent – I will happily leave that to you to decide. But I do believe that vaccines are vital to individual and public health and I don’t believe that vaccines pose a serious health risk to the overwhelming majority of people.
If a parent believes that vaccines are harmful to children, then they also believe I am either evil or incompetent. I’ve heard a lot of parents try to dance around this issue. Usually, it involves a lot of hand-waving and saying “it’s not you personally” etc. I appreciate the effort to minimize the conflict, but you can’t have it both ways. If you believe it about “doctors” then it applies to me as much as anyone. Some issues are just black-and-white, and this is one of them.
True fact: I’m a human being, as are all of the doctors I know. And we have feelings. I’m totally okay with parents questioning my thought process. However, a parent who believes that I’m intentionally making bad recommendations for their child is a totally different thing. Any medical provider would be hurt when regarded with such suspicion. I could lie and say that it’s just about the welfare of my patients. But there is this other piece, and any doctor who denies that they take it personally is lying. I do take a parent’s anti-vaccine stance personally. Particularly when they’re standing in my office asking me to care for their child.
The impact on patient care quality
Because of this, many of us have decided not to accept non-vaccinating families for either patient safety or personal reasons. Personally, I’ve decided not to go this direction, though I admit it would make my life a lot easier. My rationale is an ethical one. I don’t refuse to treat other families who make choices I don’t like. I’m not sure it’s okay to draw that line here either. But, willingness to accept families who don’t vaccinate their children comes with some baggage. Most importantly, it forces me to work with parents who don’t trust my medical judgement. And that’s uncomfortable for me.
Anti-vaccine parents have a choice to make: either work with a doctor they can’t trust (because who trusts evil or incompetent people?) or find one they do trust. Finding a doctor for your child that doesn’t believe in vaccination is difficult. So parents who don’t want to vaccinate have one choice. They have to seek medical care with doctors whose judgement and knowledge they don’t trust. What we don’t often consider is the quality of care these children receive from those willing to care for them.
Why are you here?
My ability to give good care is based in part on collaboration with families. If I walk into a visit knowing that parents don’t trust me, I can’t do my job effectively. Like any relationship, lack of trust is poisonous to the doctor-patient relationship. And as a general rule, I try to avoid dealing with people who don’t like or trust me. So I admit, I don’t spend as much time getting to know these families. I provide a service to them, but am less interested in building rapport because that is based on trust. Which we obviously don’t have. I feel terrible about it. That kind of inequality is not ideal, but it’s a natural consequence of telling me that you don’t trust my judgment.
Truthfully, I wonder why these families even come to see me. Just as I know that they don’t trust me, they must know that I think they’re exercising terrible judgement which could result in the death of their child. Who wants to see a doctor who looks at you that way? And, who takes their child to a doctor they think is incompetent (or evil) anyway? But, I still see their children and I do my best to offer objective recommendations on how to improve their child’s health. And I do this knowing I’m not doing my best work and that there’s nothing to be done about it but hope that the pendulum will swing back and I’ll be free to do the job I love.