In this insightful conversation, pediatricians Dr. Phil Boucher and Dr. Marina Capella discuss how to approach families who are hesitant or refusing vaccines. They share strategies for building trust, addressing concerns, and creating an open dialogue that empowers families to make informed decisions.
Link to podcast: Vaccine Hesitant Families
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you. Hey everyone, welcome back to another episode of DPC Pediatricians. Today, we are going to tackle a controversial issue that is in the limelight at the moment
0:21
because we’re talking about vaccine hesitant families. And I actually don’t know what Dr. Capella typically does in this. And we specifically kind of blinded ourselves to knowing in advance what we were going to talk about so that we could have a honest conversation and talk through the specifics of our approaches and those sorts of things.
0:40
I will start with saying that in the past, I was more rigid around vaccines. And I think that was part of my training. And it was part of the medical hubris that comes from training. And the pandemic really opened my eyes to not that, like, I don’t have any really anti-science. I don’t have any anti-science views.
1:10
But I realized that it’s really hard for people to make medical decisions. And they are up against a lot of information, misinformation, and disinformation, and do not have the background, do not have the training. And we all get sucked into all of the different things that we see on social media and believe in varying degrees.
1:31
And it is really hard to parse those things out and figure out who to trust and who to believe. And so that has led me to more, I guess I would say empathy or compassion for those that are having a difficult time making sense of it all,
1:43
because it’s been really hard for us as healthcare professionals to make sense of it all in the past five years. That had an impact on me. And it really affected the way that I look at those families that are having questions and concerns about vaccines.
2:00
And so what I have done over the past several years is more embraced those that are questioning and hesitant. And what that looks like, I mean, I think that there’s really like three camps. There’s pro-vaccine, pro-science, roll up my sleeves, no questions, no concerns. You got this.
2:20
And those people are easy and find pediatricians and go to pediatricians and get their vaccines and don’t have any questions. Great. There’s the large middle that believe in science and but also have questions and concerns and are facing a lot of doubt and uncertainty and anxiety because of what their in-laws say,
2:43
because what they’re seeing on their social media channels, because of the something that they heard or something that they’re concerned about or something that doesn’t really make sense to them or they were really turned off because somebody treated them very poorly that was just saying, well,
2:57
you should just do what I say because I said that and the kind of medical patriarchy had some sort of impact on them. And so I think those are really the people that we can have an impact on in helping them feel heard and understood and then help them come to that decision over time
3:14
when they’re ready and on their terms. And then the third camp are the anti-vaxxers actively working to discredit physicians and pediatricians, actively working to tear down the science bridges that have been built over time. And I don’t think we’re going to be able to help. them very much. But I think that’s a really small minority.
3:35
And I think that in a lot of practices, they get lumped together. If you have questions or concerns, you’re not welcome because you’re part of the problem. When really, if you have questions or concerns, we as pediatricians should be working to help you feel understood and heard and validated.
3:50
And then we can add in the science and what we know and our expertise from there. And so that’s kind of my three camps approach to those that have vaccine questions and concerns from the big picture. And then maybe if you can tell us, Dr. Capel, a little bit about your perspective,
4:07
and then I can talk about the specific logistical things that we do when it comes to all of that. What’s your approach or thoughts?
4:13
Yeah. Well, I really resonate with what you said earlier that before due to my training and just due to being in a more hurried clinical setting, I had less patients for vaccine hesitant families. And I think now having entered the world of DPC, where I have these much longer visits, typically an hour for a physical visit,
4:34
or a new patient, I have much more patience because I have more time. It’s this very direct relationship between the time I have and the patience that I find myself having. And I’m able to just like listen and develop that relationship with first and try to gain their trust.
4:54
And then I find that they soften quite a bit. They sort of come up with this like defensiveness. And then after, you know, by the end of the visit, I just feel like some of those defenses have come down because their baby has been treated well. They’ve been treated well.
5:09
And they’ve had someone that just takes the time to listen and to answer their questions. And so I do accept vaccine hesitant and even vaccine refusing families. I was conflicted about it at first because I definitely kind of came into it with that like, oh,
5:25
I don’t like dealing with these families kind of attitude because it was hard back when I didn’t have time. And I’ve definitely softened to it. That’s not to say that I’ve changed my own beliefs about vaccines. I still am first in line for my flu and COVID shot every year.
5:39
And I am a big believer in vaccines and the power they have to protect us as a population in general and the most vulnerable children as well.
5:49
For sure.
5:50
But I think. People are people. And when you just, you can sort of have these stereotypes about a group of people in your mind, but then when the person is in front of you, I feel like a lot of those stereotypes break down when you actually get to know them. And I would say the vast majority,
6:07
I’ve had maybe two families that are sort of rabidly anti-vaccine, but the rest of them are like, well, I… It’s not that I’m totally opposed to vaccines. I just have this concern or that concern, or I want to wait a little longer or I have these questions.
6:22
And so a lot of them really are in this kind of middle ground territory where if they develop a relationship with a provider that they trust over time, they can potentially soften that. their stance on vaccines and be open to your recommendations or be willing to maybe do a slower schedule.
6:39
But in my opinion, some vaccines are better than no vaccines. And so I’m definitely willing to work with those families. Plus, I think that kids, regardless of their parents’ choices, kids deserve the best care.
6:52
Amen. I think that that’s something that often gets lost. I feel like is if we treat them like less than, and if we tell them you’re not welcome because you have questions about vaccines and I got to get going and you need to make up your mind.
7:06
And if you don’t do what I say, then we’re going to send you a letter. Then we’re going to be pushing them understandably from their perspective towards the anti-vaccine, more rapidly anti-vaccine. Yeah. by our approach and the way that we’re doing things.
7:22
And I think what you said, the soften is just exactly what I get to experience all the time. And it’s really moments of pride for me. Just the other day, family, first baby, all sorts of medical questions, disinformation, information that we’re wading through. Hey,
7:37
here’s the two things that I think I really want you to know about going into the winter illness season. One, we have a lot of whooping cough going around. And she said, oh yeah, I saw that on your Instagram that you were talking about whooping cough.
7:47
Here’s what I need you to know about whooping cough for your two month old is that there’s risk for apnea. And then the other is RSV. And we don’t know who’s going to have a bad time with RSV. Sometimes a two week old will get RSV, sail just through just fine.
7:59
Sometimes an 11 month old will end up in the PICU. So if I had to pick right now, What I would say is the most likely things that she’s going to encounter in the next two months, it would be whooping cough and it would be RSV. And I want you guys to think on that.
8:14
And they booked an appointment right after I walked out of the room. They walked their way out. My staff said, they booked an appointment to get their vaccines later this week. I didn’t even leave the place and then text. They had that discussion in the room. And then they booked an appointment for later in the week,
8:30
knowing that they were going to come back in and get those. And in the meantime, do a little bit more of their looking and research and figuring things out. And that was like the biggest win for me as a pediatrician to say, I did not coerce them. I did not threaten them. But they decided,
8:46
based on our discussion and that mutual trust that we’ve developed over our short time together, that, OK, what my in-laws are saying, what I was seeing on X or on TikTok, I trust him. And I’m going to do what our pediatrician says,
9:02
because I can tell from our discussion that he has the best interests of me and my child in mind. And I think that what you said, too. is really powerful about our patients to not pick their parents. And so we shouldn’t jeopardize their medical care and push them towards the
9:20
alternative medicine crowd because there could be a lot of actual physical health things outside of vaccines that I as a pediatrician can help them with that they might miss out on if we push them so hard that they say pediatricians aren’t for me because they all just try and you know tell me how
9:36
it is and they all talk down to me and they all say threaten to not care for my child if I don’t do what they say and that doesn’t feel right as a pediatrician it doesn’t feel good to be like yeah I really showed them they left
9:51
Yeah, exactly. And I get, I get a fair number of calls from parents who say we’ve had negative experiences at another practice because they just are not okay with our stance on vaccines. And often it’s not complete opposition to vaccines. It’s just wanting to slow it down.
10:08
But a provider in a typical fee for service setting just doesn’t have the time to have those conversations. And I understand because you understand because we were in that system before, right? Yep. Yeah. And I agree completely with like, you know, even if we’re not vaccinating the children,
10:22
I get this misconception all the time from like parents of newborns is like, oh, if we’re not vaccinating, do we need to come in as often? And I emphasize the importance. Oh, there’s so much more. We’re going to talk about your baby’s development and we’re going to track their
10:35
growth and it’s just an opportunity for you to ask questions because so much changes over the first year of life. And it’s nice to be able to do all of that, even if they’re not doing vaccines. But we also have the opportunity to bring up the question. And I always tell parents in the beginning, look, like,
10:51
I promise I’m never going to force you to do anything that you are not comfortable with. But is it OK if I just ask every time because I have a lot of families and I can’t remember everyone’s stance and I just want to make sure that
11:03
That I’m giving you the opportunity to have that conversation at every visit.
11:08
And, you know, that’s huge. And I think that they can just a lot of like anti checkup. messaging going on on social media too, where like, you shouldn’t take your kid in because of the shots. Like people have associated, I just go in and get my shots because in the fee-for-service world,
11:24
the visits are so quick that that’s, you know, 50% of the visit is just waiting for and getting the shots. Whereas it’s like, yeah, that’s one part of it. But I also want to feel their belly to make sure they don’t have an abdominal tumor.
11:36
And I want to listen to their heart and I want to see how their development is. And I want to do this and that at those checkups, not just poke them and i think that when more people realize okay this is why we go at six
11:49
months and nine months and 12 months because we’re watching those other things then they realize that there’s value in that and it’s more opportunities to talk to them and to find out what they’re seeing and what their concerns are i always tell people too hey i’m going to tell you if there’s a measles outbreak in town
12:03
That we’re going to text you and say, hey, let’s rehab this conversation because we’ve got measles in town and I don’t want your child to get measles. And I tell them that and then they’re perfectly cool with that and they feel taken care of and knowing that. I’m still having concerns. It doesn’t feel as immediate now,
12:19
but I know that if something changes that we can reopen that discussion and have that trusted conversation.
12:25
Yeah. Really quickly, I want to make one last point. You do have to take certain precautions, right? So I tend to put a little message that I can see clearly on the chart if they’re completely unvaccinated or if they’re minimally vaccinated so that I’m more careful. If the parent is texting me on the weekend and says, hey,
12:42
my kid has a fever and a rash, it triggers me to think through some of the other possibilities in an unvaccinated child. Right. It’s also nice because we have some of my staff members are like, oh, like we’re just more scared if a kid is coming in with a rash or something that’s unvaccinated.
12:59
And I just have to reassure them, hey, I’ve kind of pre-screened them. And we have that opportunity to do that because we can text with our families and call our families instead of. in the fever service world, a kid could just show up and someone who didn’t know what they were doing over the
13:13
phone just scheduled this kid for a fever visit or a rash visit. And then all of a sudden I’ve been in that situation in my old job where it was like, oh my gosh, what do we do? We have this kid who, where can we quarantine them and who has been potentially exposed? So yeah,
13:29
we have that ability to kind of like think through it beforehand before we see them in the office and take appropriate precautions.
13:36
Well, I think that also helps families to realize, hey, I’m going to mark this down that you are behind on vaccines or not getting vaccines right now. Because if you call in with a fever, I’m going to have a different approach than my other patients. And it’s a good reminder as pediatricians, like it wasn’t always.
13:54
the fever, like, okay, just do the ibuprofen and things. It was that. And it also tells the parents, like, I’m going to take it more seriously when you have a fever compared to others, because there’s things that I worry about that my other patients I’m not worried about.
14:09
And so that kind of just also says to the parents, like, there’s some things that we need to watch out for because we’re, you know, in the vaccine preventable era, but you’re not. Yeah,
14:21
I will also say that in the back of my mind also have to just consider it’s like, OK, if I have enough vaccine, unvaccinated children in my practice, eventually probably something negative is going to happen. I kind of have to be OK with that risk.
14:35
And the way that I have the conversations with the families is like I really put the. onus on them. It’s like, look, I’m here to support you. I’m here to help with information. Ultimately, I know every parent wants to do the best for their child. And I believe that you’re making the best decisions you can. And ultimately,
14:52
you’re the one that has to deal with the consequences of either not vaccinating or vaccinating should some side effect happen. And so I really put it on them. It’s like, look, this is your child and your choice, and you’re accepting the consequences of your decision. So that’s not to say I wouldn’t be
15:10
It’s sad if something were to happen to one of the patients under my care. But I think sometimes pediatricians have difficulty that they would feel really responsible. And as long as we document appropriately and we feel like we really are giving them the opportunities to vaccinate and to get good information, it’s ultimately on the parents.
15:31
Right. Which it should be like they’re the parents. We cannot force people to do things that we don’t want to do, nor should we. And our responsibility is to educate and inform and counsel. And then parents have the right to make those choices the way that they see fit. Exactly.
15:49
Yeah. So I would say all in all, I think it’s completely up to you as the owner of your practice, what decision you make. Phil and I have both decided to accept and we found that it’s easier to actually work with these families than it was in the fee for service world. But ultimately,
16:07
it’s up to you make the decision that’s best for you, just like families are making the best decisions they can regarding their own children.
16:14
Right. And I think there’s different populations that you’ll serve whatever your policy is. And if your policy is all vaccines on time, you’ll attract those people and that will be great for your practice. And if you have somewhere in the middle or wherever you land on the spectrum,
16:29
their patients will find you and they will appreciate your stance on it.
16:34
Yeah. Just make sure to document appropriately. The American Academy of Pediatrics even has a vaccine refusal form that the parents can sign and that can help protect you from a medical legal perspective. So thanks everyone for listening. Yeah. We believe you will make the best decision for your own practice. Have a great day.
