When Doctors Fire Their Patients

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By Diane Selkirk

“You’re fired!” While this phrase may have become popular in some TV-show circles, it’s probably the last thing that a parent expects to hear during a routine visit to her child’s pediatrician. For Nipuna Dasi, a Seattle, Washington, mother of three, not only did her son’s pediatrician fire her, but Dasi also left the appointment with the concern that CPS might be following up.

Dasi’s offense? She had chosen not to vaccinate her then 9-month-old son. “I had been putting off the decision and was not ready (to vaccinate),” Dasi explains. But her new pediatrician was adamant. “She suggested he get his first series of vaccinations right then. I said, ‘No thank you.’ But she insisted and told me to wait while the nurse prepared the shots.”

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Dasi continued to decline the shots, citing the fact that her son had a cold and that she also wanted a chance to talk it through with the baby’s father. “The doctor then advised me that some doctors would call CPS on me for refusing to comply with their vaccination schedule,” she says. “I didn’t say another word. I picked up my son and diaper bag and left.”

An isolated problem?

Far from being unique, Dasi’s experience is well reflected in the results of a nationwide survey of pediatricians that was published in the Archives of Pediatrics and Adolescent Medicine. The survey studied the attitudes of pediatricians concerning parents who refused some or all of the recommended vaccination schedule for children. The results showed that 85 percent of physicians surveyed had encountered vaccine refusal by parents during the one-year study period.

Confirming Dasi’s experience, 39 percent of the physicians surveyed said they would dismiss a family for refusing all vaccines, and a further 28 percent said they would dismiss a family that wanted to selectively refuse or delay some vaccines.

The study’s lead author, Dr. Erin A. Flanagan-Klygis, an assistant professor of pediatrics at Rush Medical College in Chicago, believes this reflects an issue of diminished trust between doctor and patient. In her report, she explains that disease prevention and immunization are considered an essential part of pediatric care, with more than 90 percent of pediatricians rating the older vaccines (DaPT, MMR and HIB) as extremely important. But the rate of unvaccinated and under-vaccinated children in the United States has increased steadily since 1995 — and while most parents still consider vaccination important, many are concerned about vaccination safety.

Exam room tension

This concern can translate into tense office visits where parents’ natural concerns and desire to make informed decisions are perceived as aggressive questioning to which pediatrians are unwilling or unprepared to respond. Physicians don’t view these discussions as conversations about the risks and benefits of immunization but rather as a sign of parents’ doubting the doctor’s integrity.

This perception was reflected in the experience of Kristen Hart, a mother of three in South Carolina who was originally uncertain about whether or not to vaccinate. “I initially felt pressured to have vaccinations done, but became increasingly uneasy as I read more and more about them,” she says. Hart attempted to engage her daughter’s pediatrician in dialogue but instead was confronted with what she calls “scare tactics” when she was told her child could “become terminally ill or have horrible complications from not vaccinating.”

Hart reluctantly gave in to the pressure. “At the two-month visit, we were really pressured about vaccines and a lot of scare tactics were used,” she says. “I ended up saying ok to the shots. I was in tears as she got them and in tears for a good while after. We also went ahead with the four- and six-month rounds of shots. By the time her nine-month visit came around, I knew for certain I didn’t want her to have any more.”

At her daughter’s 15-month visit, Hart decided to tell the doctor they were done vaccinating. “The doctor said that we either needed to have her vaccinated or seek care elsewhere,” she states. “I didn’t return to that doctor.”

Desperately seeking pediatricians

Both Dasi and Hart now faced the same dilemma: they wanted a physician in their children’s lives, but they wanted one who would respect their wishes as parents. Hart explains: “I do understand that a doctor would feel so strongly about immunization that they would refuse to care for a child not immunized. But I really think that doctors should respect that parents have the final say in the care their children receive.”

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The solution for Dasi and Hart has been to use a family care physician for their children. In both cases, they have found that while the physicians don’t agree with their no-vaccination stance, they are still able work together. “She gave her advice as doctor but agreed to honor our choices as parents,” Hart explains.

Finding the Right Physician

If you have strongly held philosophies or want to ensure a type of care that falls outside of the mainstream norm, it is important to be diligent when choosing a physician.
• Gather physician names and references from friends and family who have similar views to yours.
• Ask the contentious questions of the office staff before even making that first appointment. Is the office pro-breastfeeding and well versed in extended breastfeeding? Is the doctor up-to-date in how to care for intact boys? What is the policy on not vaccinating or on selective or delayed vaccination schedules? How does the doctor feel about homeopathy and other alternative and complementary treatments? What happens if a patient declines antibiotics or other treatments?
• If you are comfortable with the office staff’s answers to your questions, book an interview with the physician.
• Ask your questions again directly to the physician. Check if other physicians in the practice will respect any arrangements you have made.

© Diane Selkirk

Diane Selkirk has stories and photos in a variety of magazines including Shared Vision, What’s Up Kids and Mothering.