Vaccine safety talks can burn up valuable checkup time
■ Half of doctors spend nearly 20 minutes discussing concerns with some parents, despite studies rejecting links between autism and immunization.
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A study suggests that pediatricians and family physicians consider holding group medical visits for parents worried about vaccine safety. Because of the amount of time needed to address immunization safety for these parents, there is a larger burden on pediatricians and family physicians to address these concerns during well-child appointments.
Physicians also could provide parents with educational materials about immunization safety and a list of reliable websites before office visits in which vaccines are scheduled to be administered, said lead study author Allison Kempe, MD, MPH.
The report, published online April 15 in the American Journal of Preventive Medicine, shows that a majority of doctors think parents' concerns about childhood vaccine safety have greatly increased during the past five years. About one in three physicians said discussing the issue during office visits is affecting his or her job negatively.
"Everyone expects parents to have questions about vaccines. But what used to be a discussion that would last several minutes is now, for some parents, lasting a great deal of time," said Dr. Kempe, a professor of pediatrics at the University of Colorado School of Medicine Anschutz Medical Campus in Aurora and director of the Children's Outcomes Research Program at The Children's Hospital in Aurora.
She said such conversations often prevent physicians from addressing additional health issues and can make doctors late to see other patients.
"Primary care physicians are already really taxed in terms of the short time they have to deliver a great deal of medical care. ... This is another additional burden," Dr. Kempe said.
Researchers surveyed 619 pediatricians and family physicians on vaccine issues between February and May 2009. The survey included questions on the prevalence of parents' immunization safety concerns and how physicians feel about having to address these issues. The doctors were members of either the American Academy of Pediatrics or the American Academy of Family Physicians.
The study found that nearly 80% of doctors have at least one vaccine refusal a month. And 89% reported at least one request a month to spread out the administration of recommended immunizations rather than giving them all during the same visit.
Physicians said discussing vaccine safety with parents can consume a significant portion of their office visits. About one in two doctors reported spending up to 19 minutes on the topic with parents who have substantial immunization concerns.
As a result of these conversations, 36% of doctors said their job is at least somewhat less satisfying. Pediatricians were more likely to be dissatisfied than family physicians.
Giving parents a personal message
Ari Brown, MD, a pediatrician in Austin, Texas, agrees that many pediatricians are tired of discussing vaccine safety. But she has noticed a decrease in parental concern about immunizations since Dr. Andrew Wakefield's license to practice medicine in the United Kingdom was revoked in May 2010.
Dr. Wakefield wrote a 1998 paper in The Lancet that purported to link autism and bowel disease to the vaccine for measles, mumps and rubella. The journal retracted the report in 2010 after it was determined the research was fraudulent. Many studies have rejected any association between autism and immunizations.
"Pediatricians are tired of the discussion [about childhood vaccine safety] because the data is so clear that there's not a link," said Dr. Brown, an AAP spokeswoman. "And vaccines are so important and paramount to what we do as pediatricians."
She said parents still ask questions about vaccine safety, but that they seem more comfortable with immunizations.
For parents who are still hesitant about vaccinating their children, Dr. Brown often gives them a personal message. "I tell them, 'I vaccinated my own kids to protect them. I wouldn't do anything different for your child,' " she said.