When the mother of an 18-month-old visited Dr. Charles Goodman's practice last week, he explained that under his new policy, the toddler would have to be immunized to remain a patient.
The woman walked out of his office.
During the current measles outbreak, Goodman and a growing number of other pediatricians nationwide are turning away parents who refuse to vaccinate their children.
Of the more than 100 people who have contracted the virus so far, the majority were unvaccinated, according to the Centers for Disease Control and Prevention.
"We decided that the patients who are not vaccinated are presenting a clear and present danger," said Goodman, who has been a pediatrician for more than 20 years. "It just wasn't fair for a small number of patients to put those many patients, who either couldn't be vaccinated because they're too young or had a weakened immune system, at risk."
Since he imposed the requirement, Goodman said, he has immunized 50 to 100 more patients who he believes would not have gotten the measles, mumps and rubella vaccine otherwise. Patients who refuse to abide by Goodman's policy have a month to find new doctors.
In setting the policy, however, Goodman is at odds with an American Academy of Pediatrics recommendation that pediatricians work with parents who refuse vaccines and not drop patients.
"The AAP feels that pediatricians are by far the best resource of information for parents who have concerns about vaccines and that if pediatricians are turning patients away from their offices, we're going to lose that opportunity to try and educate them," said Dr. Mark Sawyer, a member of the AAP Committee on Infectious Diseases. "The hope is that we'll eventually get them to be immunized."
Dr. Monica Asnani, a pediatrician with the Medical Arts Pediatric Medical Group in Los Angeles, said she saw a pattern three years ago of people getting fewer vaccines for their children. Worried about a potential outbreak, she implemented a policy requiring patients to have had at least two-thirds of recommended vaccinations.
Vaccines that Asnani recommends include diphtheria, tetanus and pertussis, haemophilus influenza type B, pneumococcal conjugate, polio and measles, mumps and rubella. She said she doesn't plan to require her patients to get all the recommended vaccines.
"My philosophy is that if I shut my door completely to people who maybe are on the fence about vaccines or want to do some and not all, they're just going to find another doctor who will accept them and not educate them," Asnani said. "And then I'm not able to protect that child."
Natasha Richard, 40, held her squirming 1-year-old son Kristian as he received his hepatitis A and measles, mumps and rubella vaccines last week in Asnani's office. Richard said she follows all of the recommendations Asnani makes and believes vaccinations are important.
"Moms should get their babies vaccinated," Richard said. "This is not a game."
Some people feel the vaccine decision should be left to parents, not doctors. One mother, who spoke on the condition of anonymity because of the potential for backlash, said she does not plan to vaccinate her 18-month-old and her 3-year-old. As a result, she was dropped from a practice that will no longer accept unvaccinated children.
Because her family also visits a family physician, who specializes in homeopathics and alternative medicine, she said they didn't have to look for someone else to replace her pediatrician.
"If I didn't have another doctor I'd be really scared, because no one is going to be accepting any unvaccinated patients right now, I would think," she said. "Every doctor should be able to have their own opinion, but having it forced upon people ... it's just not right."
Despite concerns, Goodman said he was willing to help parents who refuse to vaccinate find other doctors. Although Goodman at first feared that he would lose up to a quarter of his practice, he said that so far he has lost only five to 10 patients and has received a mostly positive reaction to the policy.
"I would encourage other pediatricians as well as family practitioners that treat children to do the same thing," Goodman said. "Put your foot down now; tell those kids they need to get the immunizations."
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