What to do when a patient refuses vaccines
Ethically, it’s wrong to vaccinate a patient against his will. But is it equally wrong to stay quiet? What’s the best way to handle vaccine refusal? Dr. Brady and Nurse Rebekah tackle this issue as we head into another flu season.
Dr. Brady: It’s often frustrating for me when I’m caring for a patient whose parents haven’t had her vaccinated. I want to give those parents a piece of my mind, but I now realize that unless they ask me for my opinion, it’s probably a waste of time—actually, a waste of time that I really don’t even have. I’m just too dang busy when I’m at work.
I definitely feel that one of my main roles as a doctor is to be a health educator, and I always do my best to fill that role. However, it’s often too hectic to spend as much time teaching as I would like. So I choose my battles, and when there is an issue I feel strongly about, but know that my audience may not be that receptive, I sneak in a quick and/or subliminal comment or piece of advice. For a young smoker, I may do no counseling at all, but rather simply ask after listening to his lungs, “Do you smoke?” in a way that scares him into thinking I can actually hear lung cells dying. For the parents of the unvaccinated, where the spin and possible conspiracy theories are all so potentially confusing, I may say something that simplifies it and breaks it down into plain English: “I have kids, too. I made sure they were vaccinated.” That is the most powerful seed I can plant.
Nurse Rebekah: I don’t have kids yet, but I make sure my dogs get vaccinated! And I’m fairly sure that I would love my kids—most of the time—even more than I love my dogs.
People tend to believe that bad things will never happen to them. Until they do. And then hindsight is 20/20, right? Your health is your choice—just don’t come crying to me in the ER when you’re having full-blown spasms from tetanus or body aches and rigor from the flu. I won’t say, “I told you so,” but you’ll know and I’ll know that you should have gotten your vaccines.
I love the debate that’s going on right now about vaccines. Whatever your viewpoint, it’s healthy for science and for healthcare in general to have a vigorous debate about vaccination. Debates move science forward. I’m hoping this debate moves forward to that common cold vaccine—one I will definitely get in line for! Or a cellulite vaccine…or a gray hair vaccine…or….
Today, more than ever before, patients come to us with their own thoughts, ideas and opinions about medical interventions. So talk to your patients. See where they stand on vaccination. Really listen to what they have to say. And then figure out where to go from there.
Brady Pregerson, MD, a returned Peace Corps volunteer and winner of the 1995 Wise Preventive Medicine Scholarship, completed his medical school at the University of California, San Diego, and his residency at Los Angeles County General Hospital. He has authored three medical pocket books for nurses and doctors, as well as the educational web sites erpocketbooks.com and gotsafety.org.
Dr. Pregerson currently works as an emergency physician in Southern California. He writes, "Although the ED environment may be quite different from working on the hospital floor or in an office setting, I am hopeful that you can take these tips and apply them to your own specific work situation." You can buy his books on lessons from the ER, including Don't Try This At Home: Lessons from the Emergency Department and Think Twice: More Lessons from the ER, at amazon.com.
By Brady Pregerson, MD