By Robert W. Sears, M.D
Few parenting topics today stir up more controversy than childhood vaccines. In the old days, patients just did whatever the doctor ordered, no questions (or at least, not too many questions) asked. But when it comes to vaccines, today’s parents want to know more…
• What are the possible side effects?
• What is the risk of catching a severe case of the diseases?
• Is mercury still in some vaccines?
• What other ingredients are in the shots?
• Do vaccines cause autism?
• Is it safe to give so many shots simultaneously?
The problem is, doctors only have about 15 minutes to spend with you at your baby’s checkup. This is just enough time to do an exam and answer some basic questions about feeding, development and behavior. If you try to throw in a dozen vaccine-related questions at the end of your visit, do you really think you’ll get some open and thorough answers?
These are what we doctors call “doorknob questions.” We think the visit is over, and we start to open the door to walk out, and the patient says, “Oh, I just have one more question.” The general rule about doorknob questions is to give the shortest, but still useful, answer possible in the 30 seconds we have left in your appointment time. So if it’s an easy question, sure, no problem. But if you try to ask questions about vaccines at the end of your appointment, good luck getting more than a doorknob answer.
And some well-meaning physicians feel so passionate about the benefits of vaccines that they will come down pretty hard on any parent who questions this institution. And, if you don’t agree to vaccinate, they may even ask you to find another pediatrician.
So how can parents get complete and unhurried answers without receiving the boot?
Plan, Research and Talk
In my office, I ask parents to make a separate vaccine consultation appointment on a day separate from any checkup or to book a double appointment for their next checkup. This way I can sit and listen to the parents’ concerns without feeling rushed, and give them the complete answers they deserve so they can make an educated decision about vaccines.
How do I respond when parents ultimately choose to delay or decline vaccines? The American Academy of Pediatrics has become increasingly sensitive to parents’ concerns when it comes to vaccines, and published new guidelines for pediatricians to follow in the 2006 Red Book of Infectious Diseases that every pediatrician views as “The Bible” on disease information and policy. The book clearly states:
• A nonjudgmental approach is best. Listen carefully and respectfully to the parent’s concerns.
• Inform the parents of the risks and benefits of each vaccine as well as the risks of each disease.
• For parents who are concerned about multiple vaccines at one visit, develop a schedule that spreads the vaccines out.
• Continued refusal to vaccinate after adequate discussion should be respected (unless the child is at significant risk of serious harm during an epidemic).
• In general, pediatricians should avoid dismissing patients from their practice solely because of refusal to vaccinate.
Now, if you expect your doctor to go over all these steps with you, do your part by not only making a separate appointment, but by thoroughly researching these issues ahead of time so you are well prepared. If your doctor senses that you are well educated on vaccines and the diseases they prevent, you’ll have a far more fruitful and mutually respectful conversation. By doing your homework and giving your doctor the time he or she needs to address your questions, together you can develop a vaccine plan that you are both comfortable with. And you won’t find yourself out on the street looking for a new pediatrician.