You're fired?

Should physicians ban unvaccinated patients?

Topics: Pediatrics, Service Lines, Primary Care

August 8, 2011

As physicians nationwide grapple with parents who are unwilling to vaccinate their children, some have decided to "fire" unvaccinated patients, noting that they pose a risk to others and reflect a lack of trust for physicians' medical advice, Time's "Healthland" reports.

Despite reassurance from public health officials that the benefits of vaccinations outweigh the possible side effects, some parents continue to obtain immunization exemptions for their children based on medical, philosophical, or religious reasons. As a result, less than 1% of children between the ages of 19 and 35 months are unvaccinated, recent CDC data show.

According to Austin, Texas-based pediatrician Ari Brown, "hot pockets" of unvaccinated children have emerged in certain communities. "Birds of a father flock together," she says, adding that "those kids attend the same preschool or charter schools—which leaves them at very high risk for vaccine preventable disease epidemics." The clusters also weaken the "herd immunity" made possible by mass vaccination, leaving infants who are too young to receive vaccines vulnerable to an outbreak, the Chicago Tribune reports.

In response, some physicians have decided to reject patients whose parents refuse to vaccinate them. Earlier this year, the Northwestern Children's Practice, an eight-physician practice in Chicago, sent a letter and email to parents announcing that the group no longer would accept patients who refused to follow the childhood immunization schedule. Between June—when they implemented the change—and July, the practice lost fewer than one dozen families, the Tribune reports.

Brown, who also rejects unvaccinated patients, says the decision to not immunize a child is "one of several differences of opinion," adding that she would not be "able to adequately provide care for a patient when their parent clearly does not respect" her medical advice. Another physician whose practice enforces a vaccine policy notes that allowing unvaccinated patients into the physician's office can put other patients at risk. "We have newborns, we have pregnant moms, we have kids with cancer who are immune-compromised, and it is a risk for them to have people coming in who have not been vaccinated" (Rochman, "Healthland," Time, 8/4; Shelton, Chicago Tribune, 7/6).