Kansas family care doctor discusses difficulties surrounding parents' refusal to vaccinate
Dr. Ryan Neuhofel, a primary care physician from Lawrence, Kansas, recently wrote an editorial about the subject, in which he said trying to convince patients who are opposed to vaccines to get them for their children has always been frustrating for him.
"Even with our deep knowledge, experience and the best intentions, our pleas often seem ineffective," Neuhofel said in the editorial. "We are usually at a loss about how to improve our sales pitch when faced with vaccine refusal. As we see vaccination rates declining in some areas, the angst among physicians is understandable."
Neuhofel noted that even though the American Association of Family Physicians (AAFP) has a policy in place that prohibits immunization exemptions, states without strong school vaccination requirements -- such as Kansas -- aren't as likely to adhere.
"Also, increasing numbers of U.S. kids are homeschooled: that number now stands at more than 1.7 million, according to the Department of Education," Neuhofel said. "So, ultimately, many patients -- children and adults -- can and will remain unvaccinated. And these unvaccinated families will be seeking primary care."
Neuhofel said growing numbers of pediatricians are refusing to treat patients whose parents refuse to get them immunized.
"I understand why practices create such policies in an effort to protect newborns and kids with weakened immune systems," he said. "I support their right to do so, but I fear these policies will only worsen vaccination rates."
This is, however, directly at odds with a doctor's responsibility to promote public health, Neuhofel believes.
"By barring the unvaccinated, we might be able to lower the risk of infections spread by sick patients in our waiting areas and exam rooms, but this practice fosters a false sense of security," Neuhofel said. "Our patients are just as likely to come in contact with unvaccinated sick children at a park, school or library -- or, as in the case of last year's measles outbreak, an amusement park. Ultimately, unvaccinated sick kids will seek care somewhere -- walk-in retail clinics, urgent care centers or ERs -- that cannot possibly proactively screen vaccine status or refuse care."
Neuhofel has decided to continue to treat unvaccinated children.
"My community has higher rates of vaccine refusal than do most in the Midwest," he said. "Through the first few years of my practice, I have had lots of opportunities to hone my message when the 'vaccine-friendly' question arises."
Neuhofel said he understands that "reasons for vaccine refusal are numerous and varied," so he attempts to avoid making assumptions.
"I've realized a single conversation in the clinic -- or even a few -- is unlikely to change someone's mind on the vaccine issue," he said. "I have found an email exchange to be a wonderful method of communication for this and other contentious issues."
Neuhofel cited a 2014 article in Family Practice Management as "a great guide on understanding the rationale behind vaccine refusals."
"The article's final section about trust rings most true to my experience," Neuhofel said. "Although most of my patient encounters will not be specifically about vaccine-related issues, each episode of care allows the patient to see I am caring for them in a rational, thoughtful manner."
Neuhofel estimated that, through patient communication, he has been able to convince the parents of 20 to 30 percent of the unvaccinated children he sees to have their children vaccinated.
"I'd love to see that number above 50 percent and hope that longer relationships can achieve that," he said.
Neuhofel feels the trend of doctors refusing to treat unvaccinated patients can only have negative effects.
"Ultimately, if we deny access, I fear vaccine skeptics' mistrust of mainstream medicine and the percentage of unvaccinated children will only grow," he said. "I think the only plausible way to convince a skeptical parent or patient is through a trusting relationship with a primary care physician."