If ever there was a hot button issue in medicine, dismissal of patients for not vaccinating is it. I fully expect to generate some heated debate with this blogpost. This is a highly controversial topic for those of us providing vaccines and caring for high risk patients. Both sides have valid arguments and, I’m sorry, but I don’t claim to have the answer to this one. I’m kind of hoping you’ll chime in and let me know your take on the matter!

It’s not a black and white decision

I am writing about this topic because I think the lay public needs to know how we, as individuals and within our specialties, struggle to make this decision. To dismiss or not to dismiss patients for not vaccinating is not a black and white issue. There is a lot of gray area here. This debate also merits attention, particularly now, because of decreasing vaccination rates and the resurgence of vaccine-preventable diseases (like measles, mumps, and pertussis).

What would you do?

For those non-medical of you out there, think on this…. If you were a medical provider, what would you do? Imagine yourself in our shoes and let’s think through the issues at hand.

Here’s the Pro-Dismissal side of the argument.

I care for patients with cancer, patients with suppressed immune systems, pregnant patients, etc. If these patients were to pick up a vaccine-preventable disease from an unvaccinated person sitting in my waiting room, it could be devastating to their health. Would I be complicit in that harm if I allowed non-vaccinated patients into my clinic? If patients don’t trust my recommendations about vaccines, why would they trust anything else I have to say? If anti-vaccine patients think I am somehow just pushing vaccines to make money and don’t care about their health, that I am motivated by greed, how can we develop a therapeutic relationship?

These are all very valid concerns! As doctors and other medical providers, we have a duty to protect our patients, particularly those most vulnerable in our community. Keeping non-vaccinating patients and families out of our offices would certainly protect that particular clinic’s community of patients.

But here’s the Anti-Dismissal side of the argument.

Just because a patient declines vaccines initially, doesn’t mean they won’t change their mind. I want to give them the chance to do that. If I dismiss them without giving them the opportunity to develop trust in me (which takes time), I certainly will never be able to bring them around. Will the dismissed patient or family be able to find quality care elsewhere? Dismissing patients for not vaccinating might drive them to find another provider who supports their anti-vaccine stance. Then they will never be given the real facts about the safety and efficacy of vaccines. That would be a disservice to the patient. It might also contribute to more clustering of non-vaccinated people and increase the risk of outbreaks. That would be a disservice to the public. If I dismiss patients for declining vaccination, will I just be feeding into the assertion that medical providers are bullies? If I dismiss non-vaccinating families, what hope will the children have to grow up hearing a pro-vaccine message? My responsibility is to care for the child, despite the undesirable choices their parents are making for them.

These are also extremely compelling points! After all, studies show that the number one driver of a patient’s decision to vaccinate is a strong recommendation from their provider. Sometimes we don’t give ourselves enough credit for the impact we can have.

Here’s where I stand

I personally tend to come down on the side of continuing to care for a patient or family that refuses vaccination. I have had too many vaccine-hesitant patients ultimately decide to vaccinate to feel like I don’t have any chance of changing their point of view. It does take time for patients to develop trust in us. And patients will have a better chance at a change of heart by staying with me than if I dismiss them to the care of an anti-vaccine provider. Also, I see vaccination as a marathon, not a sprint. I don’t mind taking the time to educate and convince slowly.

However, that being said, if a patient accused me of pushing vaccines for personal gain, I would likely dismiss them for failure to establish a therapeutic relationship. If they think that of me, then I can’t see why they would want my care. It would also be extremely difficult for me to provide care without being resentful and that does not make for a strong doctor-patient relationship. I could also imagine that it might change my stance to have an unvaccinated patient of mine transmit a dangerous, but preventable, disease to other patients.

Have you made up your mind?

Now that you’ve heard both sides, what do you think? Should doctors dismiss patients for not vaccinating? What would you do? Would it change your mind if your community was in the midst of a disease outbreak?

Please comment. Let me know your thoughts. And, as always, thanks for reading! Until next time.