White Coat, Black Art·Dr. Brian's BLOG

A U.S. survey suggests MDs should fire vaccine-refusing patients

A majority of parents vaccinate their kids against measles. Some are wary about seeing a doctor who keeps an open door to vaccine refusers.

Tell me if you treat unvaccinated kids, U.S. parents tell their doctors

In Canada, physicians cannot legally refuse to see unvaccinated patients. (Tom Stathis/Associated Press)

The World Health Organization says measles cases have tripled around the globe in the first seven months of this year compared with the same period in 2018. Most parents have their children fully vaccinated. But they're increasingly worried about meeting up with unvaccinated patients in their doctor's waiting room. Some are concerned enough to want their doctors to take action against patients who refuse vaccinations for themselves and their children.

That's according a new U.S. survey published Monday in the Mott Poll Report. It comes from the C.S. Mott Children's Hospital National Poll on Children's Health at the University of Michigan. This is a nationally representative survey of 2,032 adults who are parents of at least one child under 18 years of age.

About 43 per cent of the parents said they'd want to know if their GP provided care to unvaccinated children. And, if there were children in the office whose parents had refused all vaccines, 12 per cent of parents said they were very likely and 29 per cent were somewhat likely to look for a new doctor.

The survey conducted in February 2019 had a 60 per cent completion rate with a margin of error of plus or minus one to three percentage points.

Parents surveyed also agreed with the notion that the doctor has some responsibility to protect their families from unvaccinated patients with whom they or their children are likely to come into contact.

Other findings included:

  • 17 per cent of the parents said unvaccinated children should not use the waiting room.
  • 27 per cent said unvaccinated children should wear a mask in the waiting room to protect vulnerable patients, mainly young children, frail seniors, and those with weakened immune systems.
  • 28 per cent said an unvaccinated child should be allowed to continue using the office with no restrictions.
  • 28 per cent said the doctor should take the step of asking the parent of an unvaccinated child to find another health-care provider.

That, it turns out, is a legal and ethical hot potato.

The Canadian Medical Protective Association (CMPA), the doctors' defence organization in Canada, says physicians cannot legally refuse to see unvaccinated patients. A 2017 publication by the CMPA advises doctors to continue providing care while keeping the lines of communication with unvaccinated patients open.

There have been recent news reports of teenagers consenting to vaccines against their parents' wishes. The CMPA says doctors may vaccinate children whom they believe to be mature minors. In Quebec, the option to vaccinate consenting minors begins at age 14 years and older.

In the U.S., where several recent outbreaks of measles have occurred, the tide may be turning in favour of doctors who refuse to treat vaccine refusers. Last year, the American Academy of Pediatrics (AAP) issued a clinical report which states that it is an "acceptable option for pediatric care clinicians to dismiss families who refuse vaccines."

Canada has been spared from the scale of measles outbreaks seen elsewhere. (CBC)

But that view is not shared by all. In an opinion article published in 2018 in JAMA Pediatrics, the authors, which included a nurse, a physician and two ethicists, argued that the AAP's new approach could erode solidarity among doctors and place an increased burden on those willing to care for unvaccinated patients.

Concerns about containing the threat of measles are warranted. The United States recorded 21 new measles cases last week, raising the total number of cases for the year to 1,203 across 30 states in the worst outbreak of the virus since 1992, the U.S. Centers for Disease Control and Prevention reported Monday.

Travel advisories for Canadians

Last week, WHO said 364,808 cases were reported since the beginning of the year. That compares to 129,239 cases during the first seven months of 2018. Nearly 90,000 cases have been reported in Europe this year. That's well above the 84,462 cases reported all of last year.

WHO said these are the highest numbers since 2006, and they may be gross underestimates of the scale of the problem. Authorities believe that there are 10 cases of measles for every case reported.

Thus far, Canada has been spared from the scale of outbreaks seen elsewhere. The Public Health Agency of Canada reported two active cases of measles during the first week of August. Since the beginning of the year, 84 cases have been reported. Cases have been logged in Quebec, British Columbia, the Northwest Territories, Ontario, Alberta, New Brunswick, Saskatchewan and Manitoba.

Unless you live in a part of Canada with an active outbreak, there's little cause for concern. If parents are worried, they can ask their doctor or nurse practitioner if there are any local outbreaks, and what if any policies they have to protect vulnerable patients from those who are unvaccinated. They should check the Public Health Agency of Canada web site for travel advisories regarding measles hotspots. The CMPA says doctors should consider keeping unvaccinated patients from vulnerable populations by scheduling their respective appointments at different times of the day or week. 

And, with new cases currently being reported in the Laurentians region of Quebec, officials are advising anyone showing symptoms of measles to call doctors' offices and clinics before showing up.

We're talking about a disease that experts once thought was on the road to eradication as recently as 2000. It's astonishing that it's come to this. 

About the Author

Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.