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Telling vs. asking: the trickiness of vaccine discussions

Posted by Dr. Claire McCarthy  November 4, 2013 09:18 AM

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Thumbnail image for baby getting shot.jpgIf doctors want more kids to get vaccines, it turns out that it's better not to ask parents if they want the vaccines. It's better to just tell them the kids are getting them.

These days, there is a big push in medicine toward shared decision-making. We want patients and families to understand and own their health care decisions--and we doctors want their help in being sure we are making decisions that work for them and their lives.

But in a study of videotaped doctor visits just released in the journal Pediatrics, researchers found that when doctors took a  "participatory" approach to talking about vaccines ("Would you like Joey to get vaccines today?") rather than a "presumptive" one ("Joey is due for vaccines today"), parents were more likely to resist getting them. Like 17 times more likely. 

And when parents resisted, if docs persisted with a Joey-needs-his-vaccines response, half of the parents who had resisted went along with the vaccinations. 

While I am a big proponent of vaccines, this makes me a little uncomfortable.

This study really struck a chord with me, because I am more likely to take the Joey-is-due-for-vaccines approach myself (as were 74 percent of the doctors in the study). I am always happy to talk about any worries parents might have, and I firmly believe that when it comes to any medical treatment, including vaccines, parents are in charge. They should do what they think is best for their children.

But I worry that if I start out with a Would-you-like-Joey-to-get-vaccines approach, parents might think that I'm not sure about vaccines, and I am sure. I worry, too, that it might feel like I am putting all the onus on parents, which could make some of them anxious. Many people would rather have something bad happen "by accident" (like getting a vaccine-preventable illness) than as a result of something they did (like say yes to a vaccine). The risks of complications from a vaccine-preventable illness are always higher than the risks of a vaccine, but being a parent is scary stuff sometimes.

One part of the study that worried me was that in those taped visits, doctors only asked if parents had questions about vaccines a quarter of the time--and talked about why we give them, and possible side effects, a third of the time. That's not okay--and yet at the same time, I get it. Sometimes it feels safer to keep conversation about vaccines to a minimum. 

We have got to find a better way to do this. We have to be able to talk about vaccines, about their importance, about the questions and worries people have, about their risks and benefits and how the decisions families make affect other people around them. 

What do you think? What have you liked, or not liked, about conversations you've had with your doctor about vaccines? What could we do better? How can we docs keep children and communities safe from vaccine-preventable illnesses, and still be supportive and keep the lines of communication open?

Is there something you'd like me to write about? Leave me a message on my Facebook page--and "like" the page for links to all my MD Mama blogs as well as my blogs on Thriving and Huffington Post. 

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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