There was a recent article in the Daily Beast by a pediatrician who is staunchly pro-vaccine. In the piece he explains why he does not take on as patients the children of parents who do not intend to vaccinate (or have not vaccinated. I respect his opinion. And on a personal level, for my own children and their own pediatrician, I actually agree. I personally would rather not take my child to a doc who is willing to not vaccinate, or who at least doesn't push for it strongly--certainly would never go to anyone who was anti-vaccine outright.
But professionally, it is more complicated. Given all we promise with the Hippocratic Oath, and all that is tied up in the anti-vaccine controversy, it is actually very hard to fire kids from (or not accept them into) a practice for this reason. I will not, with very few specific exceptions, do it, and this is a change in my thinking over the past few years.I have a few reasons:
For one thing, we are punishing the child for the sins of the parents--maybe the kid likes the office, likes the staff, and because the parents are misguided, we force the kid to get used to a whole new doctor--a potentially traumatic event, depending on the connection present and the age of the child.
It is also an incredible missed opportunity for education. When we say, "we won't treat you if you don't vaccinate" we are missing a potential opportunity to try to change the mind of a parent who may actually be less certain or more on the fence than they seem. I realize there are some who are adamant and vehement and have fixed false beliefs about this. And there we may not be able to make progress. But in reality, despite what the internet would have you believe, most parents are reasonable and want what's best for their child and aren't in fact so sure what that is.
For the parents who are vehemently anti-vaccine, by firing them or not taking them on, we only feed into their distrust and suspicion of the medical community. Remember, this is a group who thinks we are in the pocket of big pharma, are experimenting on their children, etc., etc. If we say "look, I do not agree with your decision, and I am going to make you sign this sheet of paper from the AAP accepting responsibility for your decision, and I am going to push you every visit to change your mind, but I will treat your child and perform other pediatric duties" and we can get parents to agree to that, I think it earns us a lot more cred in the long run than being so confrontational as to refuse to see them at all.
Some of these kids and parents, if they don't see me (or a general pediatrician since I am not currently a generalist) they won't see anyone at all. The parents will keep them away from all medical care for any reason. And that is infinitely more dangerous for the long-term health of that child and the whole family.
So when might I fire a family? If they won't sign the waiver--if they're going to try to blame me or the system if their kid gets measles or Hib or Hep B or cervical cancer or...well, then they're out. Because that is frankly just crazy. If you make a decision as a parent, about vaccines or otherwise, you have to own it. And to me that means accepting legal responsibility for your child and their health outcomes, just as we do as parents every day in all other walks of life. If a parent won't sign that document, it throws up all kinds of red flags about what else they won't accept responsibility for and what they might, frankly, try to sue about. And at a certain point, I need to protect myself.
But beyond that, as a pediatrician, I owe it to the child to let them form a relationship with a pediatrician who will be competent and thorough. I owe it to the child to try to convince their parents to vaccinate. I owe it to the child to try my best, despite their parents, to be their pediatrician.