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Thursday, February 16th, 2012
A growing number of pediatricians are refusing to treat families who choose not to vaccinate their children, according to a report in the Wall Street Journal.
Medical associations such as the American Academy of Pediatrics don’t recommend that doctors “fire” families who opt out of vaccines. Instead they encourage pediatricians to bring the topic up at multiple visits but continue to work with families. Yet research shows that it’s increasingly common for practices to push these patients out.
From the Wall Street Journal:
In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.
By comparison, in 2001 and 2006 about 6% of physicians said they “routinely” stopped working with families due to parents’ continued vaccine refusal and 16% “sometimes” dismissed them, according to surveys conducted then by the American Academy of Pediatrics.
Many pediatricians see administering vaccines as one of their main duties in keeping children healthy, and say it’s difficult to work with families when parents and doctors don’t see eye-to-eye on this key issue.
Pediatrician Allan LaReaux of Kalamazoo, Mich., stopped treating non-vaccinating families in 2010, in part because he worries that children who have not been immunized could make others in the waiting room sick. From the Journal:
“You feel badly about losing a nice family from the practice,” [said] Dr. LaReau, but families who refused to vaccinate their kids were told that “this is going to be a difficult relationship without this core part of pediatrics.” Some families chose to go elsewhere while others agreed to have their kids inoculated.
Pamela Felice, an Atlanta mom whose family was dismissed by their pediatrician for refusing vaccines says it’s been difficult to find another doctor. One of her children has gastrointestinal problems and regressed development that she believes is related to immunizations. At least four practices have denied them a first appointment when Felice explains her opposition to vaccines.
What do you think? Do doctors have a responsibility to treat patients even if they refuse vaccines?
Image: Doctor, baby and mom via Shutterstock.
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Thursday, January 5th, 2012
The American Academy of Pediatrics issued a policy statement this week urging pediatricians to ask questions–and listen carefully–to identify warning signs that children are suffering under “toxic stress,” a chronic stress condition that can have serious health implications later in life.
Toxic stress is different from everyday stress, as it is the result of prolonged exposure to intensely difficult situations, such as abusive or neglectful family relationships, poverty, or parental substance abuse or mental illness. Health conditions including mental illness, obesity, diabetes and heart disease are linked to toxic stress.
The Boston Globe’s child development blogger, Dr. Claudia M. Gold, argues that the new statement should be seen as a call to respect–both with time and wages–the work of primary care physicians, particularly pediatricians, as they can be the first line of defense in identifying and easing toxic stress:
As a culture we need to value the primary care clinician, not only in the form of payment equal to the more lucrative subspecialties, but in the form of recognizing the role of relationships in healing. It makes sense that if we are recognizing the importance of family relationships in preventing poor health outcomes, that we should recognize the importance of doctor-patient relationships in supporting these families.
When primary care clinicians take time to carefully listen to stressed parents, parents feel supported in their efforts to carefully listen to their children, thus promoting healthy development. In turn, our culture needs to support and value primary care clinicians ( and its not only pediatricians, the subject of this policy statement, but all those entrusted with primary care of children.)
Image: Upset child, via Shutterstock.
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Monday, December 12th, 2011
Few parents of overweight children–fewer than one in four–say that their pediatricians have raised concerns over their kids’ weight, according to a new study published in the journal Archives of Pediatrics & Adolescent Medicine.
But researchers are unsure as to whether doctors are truly not raising the issues, or whether the parents are unable or unwilling to process what they’re being told. MSNBC.com reports:
“It’s tricky to say, and it’s tricky to hear,” says lead researcher Dr. Eliana Perrin of the University of North Carolina. She analyzed government health surveys that included nearly 5,000 parents of overweight children from 1999 to 2008.
Parents tend not to realize when a weight problem is creeping up on their children. When almost a third of U.S. children are at least overweight, and about 17 percent are obese, it’s harder to notice that there’s anything unusual about their own families. Plus, children change as they grow older.
The new study suggests when parents do recall a doctor noting the problem, it’s been going on for a while.
About 30 percent of the parents of overweight 12- to 15-year-olds said a doctor had alerted them, compared with just 12 percent of the parents of overweight preschoolers. Even among the parents of very obese children, only 58 percent recalled a doctor discussing it, says the report published Monday by the journal Archives of Pediatrics & Adolescent Medicine.
“Many pediatricians don’t worry until children are very overweight, or until they’re much older,” says Perrin, whose team has created stoplight-colored growth charts to help doctors explain when a problem’s brewing. “If we can notice a concerning trend early, we’re more likely to be able to do something about it.”
Image: Overweight boy, via Shutterstock.
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Monday, October 3rd, 2011
A new study published in the journal Pediatrics has found that 28 percent of American parents who vaccinate their children according to the recommended schedule think it would be safer to delay the immunizations until their children are older.
The study also found that a growing number of parents are delaying the vaccines, following an alternative schedule, or declining certain vaccines, most often the seasonal flu vaccine, for their children. More than 1 in 10 parents currently use an alternative vaccination schedule, the study reports, and “a large proportion of parents currently following the recommended schedule seem to be ‘at risk’ for switching to an alternative schedule.”
Pediatricians are aware of the parents’ concerns over vaccines, but a growing number will not treat children whose parents refuse or delay vaccines, citing both the serious dangers of the diseases the children are being vaccinated against and a lack of evidence of extreme side effects from the vaccines themselves. CNN.com reports:
“There is a small group of pediatricians, and I think it’s growing slowly, that tell patients, ‘If you come into our practice, we are immunizing your children according to the CDC’s and the American Academy of Pediatrics standard schedule,’” said Dr. William Schaffner, who chairs the department of preventive medicine at Vanderbilt University. “[They say] ‘Anything less than that is not appropriate for your child. If you’re uncomfortable with that, God bless you, here are the names of some other pediatricians in town who will likely take care of your children.’”
(image via: http://www.simplyparenting.com/articles/9)
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Monday, June 13th, 2011
Florida’s governor, Rick Scott, signed a law this month making the state the first to prohibit doctors–including pediatricians–from asking patients or patients’ parents whether they own a gun. Doctors who do ask such questions are subject to discipline by the state’s medical board. Several other states are considering similar proposals, according to an article published in The Boston Globe.
Pediatricians often counsel patients on safety issues, chiefly around swimming pools, household chemicals, bicycle safety…and guns. The Globe cited statistics that support this practice:
The idea that firearms are out of bounds for doctors, who are committed to preventing illness and injury, is preposterous, opponents said. Between 2003 and 2007, the most recent years for which data are available, 152,519 people were killed by firearms, including more than 15,000 children and teenagers, according to a US Centers for Disease Control and Prevention database that collects information from death certificates.
Gun rights groups, including the National Rifle Association, supported the bill on the grounds that it protects a family’s right to privacy. “You have a right to seek medical care without being interrogated about the private property that you own,” Marion Hammer, executive director of Unified Sportsmen of Florida and a former National Rifle Association president, told the Florida Times-Union newspaper in January.
What do you think about this new Florida law, and about the rights of doctors to advise patients on gun safety?
(image via: http://ohmdkids.org)
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