5-year-old boy for routine pre school medical check

[madhurima]

5-year-old boy is brought to the office by his mother for a routine physical examination before beginning a new school. The family recently moved to your town and this is the first time you are meeting them. The mother tells you that the child was born at term with no complications and has been healthy ever since. She tells you that she "does not believe in vaccines" and none of her 3 children have received any vaccinations. You try to explain the benefits and risks of immunizations and listen to her concerns. However, she continues to be adamant that her "children will remain unimmunized." You give her a vaccine information statement and other printed material about vaccinations. The child appears happy and healthy and a complete physical examination is normal. The most appropriate next step is to

A. call the child's new school and inform them of the child's vaccination status
B. contact the child protective services agency to report child neglect
C. document your discussion about vaccines in the patient's chart
D. inform the local board of health of the mother's decision
E. tell her that her decisions are foolish and put her children at great risk

[madhurima]

C. document your discussion about vaccines in the patient's chart

[shancheti]

Explanation:

The answer is C. In practice, you will come in contact with individuals with misconceptions about vaccines. Web sites, news programs, and other groups often put out misinformation with exaggerated side effects. It is important to discuss the benefits and risks of immunizations and to provide trustworthy material about vaccines. If you are unable to change the person's mind, you need to document your discussion in the patient's chart to reduce liability if this patient were to contract a vaccine-preventable disease.

It is inappropriate to call the child's new school and inform them of the child's vaccination status (choice A). Schools often require a vaccination history prior to entry so they will most likely be aware of the situation soon.

You should not contact the child protective services agency to report child neglect (choice B). Neglect is when a caretaker fails to provide adequate nutrition, supervision, or medical care for a child. Even though it seems neglectful to withhold vaccinations from a child, it is not something that has to be reported as neglect.

While it seems like it might be important to inform the local board of health of the mother's decision (choice D), it is not appropriate. The child's school will soon find out that the child is unimmunized and decide whether or not to allow entry. As the physician, you should try to persuade her to vaccinate her children, and if she refuses, you should document it in the chart. The local board of health is where you report notifiable diseases, such as gonorrhea and syphilis.

Since you want to establish a good physician-patient relationship with this family with hopes of changing her mind about vaccines, it is wrong to insult her by telling her that her decisions are foolish and are putting her children at great risk (choice E). You should explain the benefits and risks of immunizations and try to persuade her that vaccinations are routinely given with few side effects. You should not insult her or else she may not come back. This might sound good, but you want to provide the best care and going forward you want to try and help her understand the truth about vaccines.