As the rise in measles outbreaks continues, learning how to deal with patients against vaccines is a critical issue for doctors. How can you promote the health and safety of your patients when their decisions to refuse vaccines threaten public safety? How do you reason with patients who insist on the harmful effects of vaccines against overwhelming evidence to the contrary?
According to a recent CBS news poll, 66% of Americans say MMR vaccines should be required, leaving nearly a third who think parents should be able to decide, even with the recent outbreaks. In January alone, 102 cases of measles were reported. Most of these cases were in California where the outbreak was linked to Disneyland. In contrast, last year's total of US measles cases was 644.
The cause of this surge in measles cases? Anti-vaxxer patients who identify with natural or alternative health movements and buy the anti vaccine movement's wildly unsubstantiated claims that link vaccines to autism.
Because many anti-vaxxer patients are emotionally motivated by fear, it can be difficult or even impossible to convince them to vaccinate. However, some patients may change their minds about vaccines if you approach them in a consistent, empathetic way with the following strategies.
Don’t make vaccines a topic for debate.
When it’s time to vaccinate your patient, don’t ask the parent whether they want to vaccinate their child today. Instead, say it’s time for their vaccines. Assuming that parents will want to discuss vaccines or explicitly providing an option can perpetuate the view that vaccines are a risky decision. Default to stating rather than asking patient about vaccines, and then open the topic for discussion only if the patient has concerns.
Don’t assume everyone understands vaccinations.
Vaccines do their job. They keep our society from seeing the impact of serious illnesses. This means for many, vaccines may seem an unnecessary risk. David Ropeik, a risk perception expert and instructor at Harvard University, told NBC news "This has always been an issue of risk versus benefit. Why should they take the small risk of the vaccine if the disease isn't around?" If a parent is apprehensive about a vaccination, explain the risks of the disease and the symptoms and long-term effects. Ensure parents understand the danger diseases like measles pose to children, as well as the responsibilities of isolating and treating the illness.
Ask what their concerns are.
Understanding parents’ fears is the first step to overcoming them. Don’t jump to conclusions or assume parents’ reasons for choosing not to vaccinate. Some parents may know a child who suffered adverse reactions from a vaccine, some may have drawn conclusions from their own research. Find out why a parent is hesitant before jumping to persuasion. Also, remember anti-vaxxers come from a wide range of economic and ideological backgrounds. As Tara Haelle puts it in Forbes, “[Anti-vaxxers] are less likely to think their children will catch a vaccine-preventable disease and more likely to know a child supposedly hurt by a vaccine...As a group, non-vaccinating parents have only one characteristic in common: They don’t vaccinate. That’s it."
Don’t use facts as a fear tactic.
While informing your patients about vaccines is important, overwhelming anti-vaxxers with facts and statistics can isolate your patient and hurt your relationship with the patient. A study published in the journal Pediatrics found that informative interventions can actually make parents less likely to vaccinate. Dr. Gary L. Freed of the University of Michigan, one of the study’s authors, says that the best course of action is instead to emphasize concern for the child. Parents who don’t vaccinate make the choice they think is best for their child. Though they may be misinformed, they’re acting from a place of love, and fear is no way to change their minds.
Make it an ongoing conversation.
Most parents will eventually vaccinate their children. Some will delay vaccinations or space them out over time. As a physician, it’s important to remember that some prevention is better than none. Even though delaying vaccines increases risk with no added benefit, that protection is better than an outright refusal. Even if parents have refused vaccines in the past, continue to bring them up at each appointment. Do what you can, don’t be afraid to raise the issue, and make sure parents know you’re always available to answer questions.
Evaluate your relationship.
In most cases, a patient decision not to vaccinate is a personal choice that doesn’t reflect on the doctor-patient relationship. But a greater personal connection with these patients could help you change their minds. Evaluate your bedside manner. Is this evidence of a physician-patient relationship that needs improvement? Could you do more to build trust and personal connection with that patient, or your patients in general? Be sure to emphasize an empathetic approach to patient communication. Consider also sending your anti-vaxxer patients to another physician if you feel their decision not to vaccinate will greatly impact you doctor-patient relationship. Have a list of doctors you trust on hand, and advise them in making the transition.
Consider whether to turn away anti-vaxxers.
Some doctors have started turning away anti-vaxxers from their practice. The AAFP recommends that in most cases doctors should respect patients' decisions about vaccines. However, if you feel their decision is impacting your doctor-patient relationship or significantly affecting the health and safety of your other patients, consider creating a policy for turning anti-vaxxers away. Be sure to explain the reasoning behind this policy to patients. Eric Ball, a pediatrician in Ladera Ranch, California, explained his tactic to NPR: “"For our existing patients who have chosen not to vaccinate, we'll likely give them a set amount of time to come in and discuss with the doctor a catch-up schedule for their vaccinations.” If the patients choose to forgo vaccination, they’re recommended to another practice. A very strong statement like this may even have enough power to change the minds of your anti-vaxxer patients, especially if it’s coming from a doctor who they trust and respect.
The best advice of all: don’t lose hope. In some cases, the only remedy to a vehement distrust of vaccines is time. John Tozzi points out in Bloomberg, “There’s a great distance between the laboratory and the kitchen tables of parents who surely genuinely care about their kids.” That distance may take a while to cross, but it’s worth the journey.
How do you approach patients against vaccines in your practice?