Do you want your doctor’s opinion? I mean why see a doctor if not for his MEDICAL opinion. But when a doctor’s personal views impact his ability to treat a patient of whom he disapproves to the point of “firing” noncompliant patients, has the doctor gone too far?
There are many reports of doctors “firing” patients whose parents won’t have them vaccinated. It is argued here that knowing your doctor’s personal opinions is empowering for patients, even if patients get fired. (By the way, I am pro-vaccine, in case that is relevant.)
Some doctors don’t want to treat patients who smoke, and they can’t be forced to. Some doctors have refused to see obese patients, and they can’t be forced to. There are bills supporting the ability of doctors to refuse to treat gay patients. Some doctors have refused to treat women who have had abortions. You can search any of these subjects and find news reports about the same.
There are doctors who won’t accept patients with certain health insurance plans. It is beneficial for patients to know that doctors are human beings with the same susceptibility to prejudices, viewpoints, and personality quirks that everyone else has. And that includes the vaccination issue.
Doctors have been “choosing” patients for decades. But as consumers, it helps us to know about a doctor’s views, especially in the world of Obamacare where our choices are frequently limited to a few providers whom we choose based on appointment availability, geographical location, and perhaps how long we’re left sitting in the waiting room long before we get the luxury of “choosing” doctors based on their personalities and views let alone their competence.
I believe it’s a gift to consumers and that consumers owe it to each other to disclose everything they can about a particular physician whom they see and so I disagree with proposals to revoke the license of anti-vaccination physicians.
In terms of medical ethics doctors have been given room to be their best or worst selves as described in the examples of physician choice described above among others. Vaccination is no different. But interestingly, in the face of the current anti-vaccination focus stemming from measles outbreaks, we see physicians criticizing those physicians who exercise free speech and are anti-vaccination.
The issue has been addressed by Dr. Arthur Caplan of NYU who in an opinion piece in washingtonpost.com, “Revoke the license of any doctor who opposes vaccination,” 2/6/2015, points out the higher level of responsibility medical speech from a physician should be held to when he speaks “…in his role as an expert.” For Dr. Caplan, the issue seems to be that physicians who speak against vaccinations are “purveying junk science,” and therefore should have their licenses revoked.
Yet there are other areas of medical practice that have been called “junk science.” There are physicians who don’t believe in alternative medicine, yet we haven’t seen a movement to revoke their licenses. As a matter of record, on July 2, 2013, in USA Today, usa.com, “Book Raises Alarms About Alternative Medicine,” Liz Szabo wrote that Dr. Caplan noted the psychological and spiritual benefits people might get from alternative healers but warned that such patients, “…may be putting themselves at risk.” Dr. Caplan did not advocate medical doctors having their licenses revoked for including complementary and alternative medicine (CAM) as part of their integrative practices in that article.
It would also be interesting to hear more physicians stand up against defensive medicine defined by Wikipedia as, referring “…to the practice of recommending a diagnostic test or treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against the patient as potential plaintiff.” Certainly this practice jeopardizes patients’ wallets and health since not all tests occur without complication. And without a doubt, non-medically indicated “procedures” are to me, junk science.
So what is it that bothers Dr. Caplan so much about anti-vaxxers that has him advocating revoking medical licenses? Based on the opinion article cited above, it seems to me it’s the issue of doctors advising against vaccines that has made him so angry because the medical speech actively discourages individuals from getting vaccinated.
But I think Dr. Caplan may be missing several points. First, many parents have already made up their minds when they come to see the pediatrician about whether they will or will not vaccinate. At most, the pediatrician can recommend and try to persuade one way or the other. The second is that in the face of pediatricians “firing” patients, voluntarily denying their skills to children whose parents choose not to vaccinate, it’s important that options are available for these parents, including those physicians who agree with the parents.
There is also a third reason that singling out anti-vax physicians doesn’t make sense in our healthcare system and that’s because doctors give advice based on other priorities besides patient health frequently.
Consider oncologists having end of life discussions with patients that include discussions of the financial cost of care and how it might not be worth it. Physician recommendations based on money are by definition not science. Consider defensive medicine. Consider physicians incorrectly but lawfully prescribing ADHD medications (reported 5/6/2013, “Majority of Pediatricians Not Following Treatment Guidelines for ADHD in Preschoolers,” Sandy Calhoun Rice, Healthline News). That’s MAJORITY. That too is junk science.
Finally, it’s important to note that there is always a risk with vaccinations and that risk is assessed differently by different people, including physicians. The CDC reports on its page CDC.gov/vaccines, “Possible Side effects from vaccines,” that for the MMR, measles, mumps, rubella vaccine that the MMR VIS warns parents that although severe allergic reaction occur in less than one out of a million doses that severe problems have and do occur.
Advising a parent to get a vaccine for a child as 100 percent safe would also be junk science. To overcome this risk, the federal government requires that parents are provided (and patients) with a VIS, Vaccination Information Statements prior to having their children vaccinated.
It’s hard to defend an approach that will revoke a doctor’s license for using fear-mongering to influence people to not vaccinate while not revoking licenses for using fear-mongering to get patients to go for unnecessary tests in the form of defensive medicine. Yet, physicians practice defensive medicine and are not accused of practicing junk medicine or of putting patients at unnecessary risk.
For consumers, physicians are required to put the information before them in the VIS and they can currently choose for themselves whether or not to vaccinate. In terms of the physicians’ point of view and the actions they take, I think the practice of medicine in the US has provided physicians with the option to treat or not treat any patient they like and that consumers can only benefit from knowing what makes a specific doctor tick in terms of his own judgments and priorities in treating or not treating patients.
