Dr. Besser's Notebook: Vaccination? Let's Talk

Mach 5, 2010— -- This is part of a weekly column by Dr. Richard Besser that examines public health issues across the nation.

In the mid-90s, after completing training in public health at the Centers for Disease Control and Prevention, I took a job as an assistant professor at the University of California at San Diego.

My main job was to teach pediatrics, but I also spent 2½ days each week working as a general pediatrician in a busy practice run by faculty at the university. It was the first time I had worked as a practicing pediatrician since completing my training.

What a pleasure it was to see a patient and a parent, listen to their concerns and work to provide care.

When the day was over, I would sometimes visit with prospective first-time parents. Expectant mothers would interview me to learn about our practice, our hours, philosophy and services.

I'd use the time to let them know what to expect in the early days after their baby was born, and to answer questions. I really enjoyed these conversations. What a great way to develop a relationship of openness and trust.

During one of these visits, a woman in her mid-30s asked me what I thought about vaccinations. She had done some reading and decided she did not want to vaccinate her baby.

She believed it was better for her baby to develop natural immunity to infections, and that vaccines were dangerous. She felt very strongly about this.

It had been a long day, and this patient clearly pushed one of my buttons.

"Of all the things we do in pediatrics, no one thing has had the impact on children's health as vaccination," I told her. "Nothing we do has as much evidence behind it as vaccination. I've seen children die from diseases that vaccines could prevent. I could work with you if you want to alter the vaccination schedule, but not vaccinate? I don't think we'd be a good fit for each other."

That was the last time I saw that woman, and I expect she went to another practice.

Over the past 15 years, my feelings about vaccination have not changed. The evidence of their benefits and safety has grown even stronger. However, I think I've matured in my approach. Faced with the same expectant mother today, I hope I would have a different conversation, one that would engender trust rather than judgment.

Today, I hope I'd say:

"You know, vaccination is something I feel very strongly about. Let's talk about your concerns."

I hope over time I'd develop a relationship of trust and help her to make informed decisions about her children's health. I'd discuss how her decision to not vaccinate affects not only her children but other children in the community.

Perhaps I'd change her mind, but I might not. I hope I'd gain a better understanding of how to talk about benefits and risks, and how to give all the parents in my practice the power to make the best decisions for the health of all children.