As a locum tenens traveling around the country, you get to see what it is like to work in many different healthcare organizations. You have the opportunity to work in urban and rural communities, as well as meet many different patients and their families. If you’re a locum tenens pediatrician (or a permanent one), one issue that you may have to deal with is managing parental vaccine refusals.
New Policy Changes
Many physicians across the country have struggled with how to deal with parents that refuse to get their children vaccinated. Should they continue treating the families and put their other patients at risk, or dismiss them? Doctors may now have an answer. The American Academy of Pediatrics (AAP) has recently announced a policy change regarding parental vaccine refusals. Pediatricians can now dismiss families who refuse to get their children immunized, but only as a last resort.
In another related policy, they also called for the end of non-medical exemptions for immunization. In the statement, they said, “The AAP views non-medical exemptions to school-required immunizations as inappropriate for individual, public health, and ethical reasons and advocates for their elimination.”
Reasons for the Policy Changes
In 2006 during the Periodic Survey of Fellows, the AAP found that 75 percent of pediatricians surveyed had faced parents who refused a vaccine. In a follow-up survey in 2013, they found that number increased to 87 percent of pediatricians. In previous policy, the AAP was against dismissing families that refuse vaccines, but because of rising refusal rates and physician frustration, policy changes were necessary.
How Do I Deal with Parental Vaccine Refusals?
As a locum tenens, you may run into a parent that refuses to get their children vaccinated. How should you deal with that? What can you do to persuade parents to get their parents vaccinated?
Understand the Role of Pediatricians
Pediatricians play an important role in curbing parental vaccine refusals. As a physician, you should work on building honest relationships with your patients and their families. This is a huge first step in convincing a parent that their child should be immunized against preventable diseases. If you are able to address parental concerns and also effectively communicate the benefits of vaccines, you have a significantly higher chance of parents accepting vaccines for their children.
Be sure that you remain up-to-date with the current recommended vaccine schedule. The schedule as approved by the Center for Disease Prevention and Control is the only evidence-based schedule that has been verified by multiple respected experts for safety and efficacy. Don’t suggest delaying or deferring vaccines may be a safer option, as there is no evidence to support that viewpoint.
Speaking with Parents about Child Immunization
When you are dealing with a parent that does not want their child to be vaccinated, it can be quite frustrating. Knowing how to talk to parents can help you have a more positive experience, and eventually lead to less parental vaccine refusals.
In talking to parents, be sure that you take all of their worries seriously. When you acknowledge a parent’s concern, be sure to also correct any misconceptions. You need to clearly explain that vaccines are safe and effective, but also articulate the dangers of the serious diseases a child can contract if they are not protected. Have a parent verbalize their concerns, and then give a focused response.
One strategy a pediatrician can take when it comes time for this conversation is to present vaccine recommendations as required protection to maintain optimal disease prevention. Also, consider using personal examples or anecdotes rather than just clinical data. Parents refusing vaccinations for their children are more likely to be swayed if they know that you had your children or grandchildren vaccinated.
As a last resort, doctors can inform parents that they must either vaccinate children or be dismissed.
Dismissing Parents who Refuse Vaccination
Some parents just simply cannot be persuaded to protect their kids. With the new policy changes, pediatricians can dismiss those families that will not vaccinate their children. This decision should not be taken lightly.
One of the reasons that a physician should consider dismissing a family is because non-vaccinating families may all go to the same practice, which will put that local area in danger for outbreaks. Another reason is that continuing to care for these families could expose other patients to vaccine-preventable diseases. This is extremely dangerous for babies in waiting rooms that are too young to be vaccinated, but still able to contract diseases.
Terms of Dismissal
If you do decide to dismiss a family due to parental vaccination refusals, it must be done in a manner that is consistent with applicable state laws, which prohibit abandoning patients. Though these vary from state to state, there are some basic requirements that will likely be the same for all states:
- Official notification to the parents or legal guardians is required
- A provision of information for finding a new physician
- The dismissing physician is obligated to continue current treatment and emergency care for a reasonable period of time (typically 30 days)
Considerations for Dismissal
Often times, employees that are part of a large hospital or organization will be unable to dismiss patients due to official policy. However, there are other times where one should consider continuing to see a family that refuses to vaccinate their children.
If you are working in an area with limited access to pediatric care, you should carefully evaluate the availability of other physicians in your area. If you dismiss this family, will they be able to find pediatric care somewhere else nearby? If there are no other qualified physicians in the area, then you should consider allowing the family to continue to see you.
With a rising trend of parental vaccine refusals, if you have not already run into this issue, you can expect to during your career. Convincing the parent that immunization is the right thing for their child will not be easy, but if you are patient and are willing to listen to concerns and correct misconceptions, you may be able to help parents make the best decisions for their children’s health.