Dismissing the family who refuses vaccines: a study of pediatrician attitudes.

BACKGROUND Parent refusal or deliberate delay of their child's vaccinations poses a challenge for pediatricians. Some pediatricians may choose to dismiss these families from their practice. OBJECTIVES To describe pediatricians' responses to scenarios of vaccine refusal, identify reasons pediatricians cite for both parent refusal and family dismissal, and illustrate pediatrician attitudes about well-established vs newer recommended vaccines. DESIGN/METHODS We conducted a nationwide survey mailed to 1004 randomly selected American Academy of Pediatrics (Elk Grove Village, Ill) members. RESULTS Fifty-four percent faced total vaccine refusal during a 12-month period. Pediatricians cited safety concerns as a top reason for parent refusal. Thirty-nine percent said they would dismiss a family for refusing all vaccinations. Twenty-eight percent said they would dismiss a family for refusing select vaccines. Pediatrician dismissers were not significantly different from nondismissers with respect to age, sex, and number of years in practice. Pediatrician dismissers were more likely than nondismissers to view traditional vaccines (diphtheria and tetanus toxoids and acellular pertussis; inactivated poliovirus; Haemophilus influenzae type b; measles, mumps, and rubella) as "extremely important," but they were no more likely to view newer vaccines (7-valent pneumococcal conjugate, varicella-zoster virus, hepatitis B) as "extremely important." CONCLUSIONS Pediatricians commonly face vaccine refusal that they perceive to be due to parent safety concerns. In response, many pediatricians say they would discontinue care for families refusing some or all vaccines. This willingness to dismiss refusing families is inconsistent with an apparent ambivalence about newer, yet recommended, vaccines. The practice of family dismissal needs further study to examine its actual impact on vaccination rates, access to care, and doctor-patient relations.