Docs 'firing' patients for refusing to be vaccinated? What say you...

[JPINFV]

Sort of, but can't we say the same about Gramps in the waiting room who is hacking up flu droplets because he did not take the antibiotics for his lower lobar pneumonia?

1. The flu is a virus, while there are antivirals out there, they are only effective if given relatively soon, antibiotics does nothing for it.

2. The vaccine for influenza isn't nearly as effective, both at preventing and herd immunity as, say, polio.

3. The medical consequences of the flu, and say, polio are no where near the same. Heck, the medical consequences of pneumococcal infection and, say, polio aren't even comparible.

I provided the wrong link for which I apologise; the correct source is Cole's Medical Practice in New Zeal which does on page 40 state that a physician may terminate a relationship with their patient only when they are incompetent to care for the patient ; see here http://www.mcnz.org....0-%20george.pdf

NB termination of a relationship and discharge are not the same thing as I wondered about that but it seems they're separate

Physicians should not be subject to any law, rule or standard less natural or fair than any other member of the community and should not be "held hostage" but we must carefully balance the right of the patient to have their beliefs and choices respected and whatever right is applicable to the physician that would apply in this circumstance.

Let's pull out the entire quote shall we as just throwing out the term "incompetent" is disengerous.

"A doctor may decide to discontinue seeing a patient only when there is a breakdown in the patient doctor relationship such that the doctor is rendered incompetent to treat the patient"

Yes, a patient who refuses to follow orders to the point that it puts everyone else in the physician's practice at abject and unncessary risk would easily lead to such a breakdown as to render the physician incompetent to see the patient.

Let me put this another way, if I harp on you every single time you see or call me that you need to be vaccinated, how toxic of a patient-physician relationship do you think that is going to be?

Finally, if physicians cannot be subject to any law, rule, or standard less natural or fair, then how about the ability to refuse service to anyone. How many other professions or services lack the ability to refuse service?

I couldn't find that reason on the GMC documents, perhaps I am not looking in the right place or you are referencing another?

I'm sorry, it's paragraph 7. Read the astrick regarding what it means with the antidiscrimination clause. Being non-compliant in a way that's dangerous isn't the same as discriminating a patient because they are Jewish or Muslim, or anything else.

Paragraph 38 of Good Medical Practice states a relationship may only be ended in "rare circumstances" citing theft, assault or violence as specific examples; see here http://www.gmc-uk.or...lationships.asp

To the subject of the non complaint patient, if a patient is persistently non compliant with all treatment and is making it impossible for the Physician to treat the patient then I think it is reasonable that the Physician be allowed to find another Physician for that patient because they (the first Physician) is actually incapable of caring for the patient because they are so non compliant.

Not taking a vaccination is not the same thing.

"or has persistently acted inconsiderately or unreasonably."

There, I again added the part you like leaving off. Refusing vaccination is unreasonable. Heck, I'll soften it. If the patient can get a signed affidavit by a religious leader, then fine. If it's "ZOMG AUTISM" than it's unreasonable and inconsiderate to everyone else in the physician's practice.

Again, shall we play the "how toxic of a relationship can I easily make this be" game?

That's a bit snobbish is it not; if your professional association advises against something (whatever it may be) wouldn't is be a bit foolish to tell them to pound sand as you say?

Next minute .... tens of millions of dollars lawsuit; I need me a new private jet

Outside of the push against Obamacare, membership in the AMA and the American Osteopathic Association (AOA, the DO equiliviant) are dropping like rocks with physcians seeking membership of their specific specialty groups. The AMA/AOA are not the only games in town when it comes to professional association for physicians in the US. Furthermore, to say that physicians must bend their knee to the AMA/AOA would be like saying EMTs and paramedics in the USA must bend their knees to the NAEMT. Shall we solicit the board for views on the NAEMT?

[Kiwiology]

Finally, if physicians cannot be subject to any law, rule, or standard less natural or fair, then how about the ability to refuse service to anyone. How many other professions or services lack the ability to refuse service?

I know the Fire Service (here) has to respond to any call for assistance, I think in your parts the ambulance service cannot not respond (whereas we can) um, those are just two examples off the top of my head, maybe not the best ones.

"or has persistently acted inconsiderately or unreasonably."

There, I again added the part you like leaving off. Refusing vaccination is unreasonable. Heck, I'll soften it. If the patient can get a signed affidavit by a religious leader, then fine. If it's "ZOMG AUTISM" than it's unreasonable and inconsiderate to everyone else in the physician's practice.

Selective interpretation - persistently being unreasonable or non compliant is not the same as choosing to not take one piece of the healthcare pie; I didn't fill a prescription from my doctor once but have agreed to every other investigation or course of treatment she has recommended in the nearly thirty years I have been seeing her. Does that make me unreasonable and should she stop seeing me?

Again, shall we play the "how toxic of a relationship can I easily make this be" game?

What are you, my two ex wives?

Outside of the push against Obamacare, membership in the AMA and the American Osteopathic Association (AOA, the DO equiliviant) are dropping like rocks with physcians seeking membership of their specific specialty groups. The AMA/AOA are not the only games in town when it comes to professional association for physicians in the US. Furthermore, to say that physicians must bend their knee to the AMA/AOA would be like saying EMTs and paramedics in the USA must bend their knees to the NAEMT. Shall we solicit the board for views on the NAEMT?

I did not say that you had to do what the AMA said, but it would be considered professionally prudent to listen to their advice and perhaps abide by it considering they are the professional association.

So who actually sets professional/ethical standards around such things as these for Physicians in the US that are enforceable?

I tried to find a professional statement from the governing body equivalent to the Royal Australasian College of Paediatrics and found no less than 3-4 different organisations. I have run across this problem before with Emergency Medicine, you have the American College of Emergency Physicians, American Board of Emergency Medicine, American College of Osteopathic Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Board of Emergency Medicine and the American Academy of Emergency Medicine!!

[BillKaneEMT]

I know the Fire Service (here) has to respond to any call for assistance, I think in your parts the ambulance service cannot not respond (whereas we can) um, those are just two examples off the top of my head, maybe not the best ones.

This may vary by locality. For us, if a scene is considered unsafe then technically we can't enter until it's secured by law enforcement. Of course, scene safety is determined by individuals on said scene and you need to use your own judgement. This places all responsibility on the responder and protects the service

I say technically because my class was taught by a guy who'd been a firefighter/paramedic for almost 30 years and he had his own special way of teaching. He'd explain the rules/laws/protocols in detail, make sure we understood how the state wanted it done, then relate to us exactly how things worked in real life and how rules like the scene safety one are written specifically to give us enormous leeway in how to handle situations. Then he would set up some hellishly evil scenario in which all the people we dealt with were secretly escaped convict cultist cannibals or something and we'd try to do things by the book and get tricked, murdered and eaten. Then he'd get about 3 inches away from your face and bellow like an angry grizzly bear for 10 minutes or so. 13 of us out of 35 passed the class. I think it took me 2 or 3 months to even survive a damn scenario but I'm grateful now. Hated him back then of course All of us were shocked at how ridiculously easy the state practical testing was compared to what we had gone through in the class:P We got together afterward: "What the hell was that about, they didn't even try one diabolical trick?" "What is this, some kind of ultra sneaky trap? I never even had the examiner declare a scene safe then have another sneak in midway through the station, put a gun to my head and yell BANG YOU'RE DEAD!" Of course, what it really came down was: Better to fail in class and get yelled at then fail at a scene and get yourself/your partner/you patient killed.

Sorry, got totally off topic there. The point I was trying for there, I think, is that local services will nearly always respond but according to the state they're actually not allowed to do so unless a scene is "secure". According to the state your priority list is supposed to go yourself, your partner, your patient, then bystanders. When I was with our paramedic unit it wasn't nearly so cut and dry but that's how the state wants it. So lip service is paid but how it would really shake out in the field may be entirely different.

edit: spelling

Edited February 19, 2012 by BillKaneEMT

[ERDoc]

Let's be clear on one thing. This is not a debate about the state pushing vaccines on anyone. Here in the US, in theory, physicians are NOT employees of the state. Most of them have their own private practices and are therefore small business owners and have the rights of a small business owner. As such (with the exception of Emergency Medicine) they have the right to pick and chose who they allow into their practice. It is not like the physician is leaving the patient without care. The parents can always find another physician.

As for the AMA, they are a joke. They do not represent most physicians. I think their membership is less than 40% of all physicians. They have no credentialing or licensing authority.

[aussiephil]

I think, regardless of what is said & ethical debates, this is a matter if choice.

I would like to state for the record that my children are vaccinated.

I do however have to respect a person if they have enough conviction to risk their children's well being by choosing not to.

I cannot however respect a doctors bullying attitude to refuse to treat said families. Regardless of his or her personal opinion.

Does this mean this same doctor who won't treat that family will not treat the 34 year old who is now addicted to pain killers following a motor vehicle accident that he had been writing prescriptions for because he is now taking the high moral ground?

Before you say there is a difference I know there is but in my mind this is a bullying tactic to take free choice from people.

If I choose, through free choice, to partake in a sport, say base jumping, & get hurt, I will be treated in the ER but does my GP now have the right to refuse treatment because he or she does not agree with my lifestyle choice?

[ERDoc]

Aussiephil, you bring up a few good points. No one is being bullied in this case. The physician is simply saying, "You and I have different opinions on what is best You would be better served finding someone who shares in your beliefs." These parents are not being reported to CPS or put on some blacklist. You say that the bullying is being used, "to take free choice from people." Are you not taking free choice away from the physician? So, does no one on here believe in the autonomy of the physician? Should a lawyer be required to take all cases that come their way?

You also bring up BASE jumping. There has been some discussions about making people responsible for their own bills when they do things such as extreme sports. Most of it comes from the insurance industry (yeah, biased I know). There was some talk from an incident on Mt. Ranier or Mt. Hood a few years ago about making people who get lost/hurt doing such things, pay for the SAR resources (there goes Washington State trying to save money again).

[JPINFV]

If your base jumping has the ability to put the patients in my waiting room at risk, then sure. Somehow I don't see that happening with BASE jumping.

[Kiwiology]

Here in the US, in theory, physicians are NOT employees of the state. Most of them have their own private practices and are therefore small business owners and have the rights of a small business owner.

Physicians are not employees of the state here either nor in any other public health care system I know of with the exception of the National Health Service in the UK (England) where Doctors are employed the specified NHS Trust, but with the NHS GP's are the exception they are private entities contracted by the NHS.

As such (with the exception of Emergency Medicine) they have the right to pick and chose who they allow into their practice. It is not like the physician is leaving the patient without care. The parents can always find another physician.

Physicians have the right to choose who they see here too but once they have taken that person on as their patient then they can only get out of it by discharging them as care is no longer required or can end being their Physician but must do so only if they are incompetent to care for that patient (see my previous posts).

When I say a Physician has a right to choose who they see, I am generally referring to GP's who most of the time are closed to accepting new patients because they are full. A Consultant Physician in private practice e.g. a surgeon can also not see you but must refer you to the most appropriate person if he's not it.

As for the AMA, they are a joke. They do not represent most physicians. I think their membership is less than 40% of all physicians. They have no credentialing or licensing authority.

The Centre for the Advancement of Kiwiology in Medicine ain't doing too flash hot either ow pretty stink bro no ghost chips required

The physician is simply saying, "You and I have different opinions on what is best You would be better served finding someone who shares in your beliefs." These parents are not being reported to CPS or put on some blacklist. You say that the bullying is being used, "to take free choice from people." Are you not taking free choice away from the physician? So, does no one on here believe in the autonomy of the physician? Should a lawyer be required to take all cases that come their way?

I believe all people are entitled to autonomy and free choice, except you, you must take me on as your Registrar, there will be no arguing about it, it does not matter that I answered "ask the Consultant" 372 times on USMLE Step 1 and that all my stations for Step 2 consisted of "I don't know this is the House Surgeon's job, I would be on a break or chatting up the nurses or female house surgeon or something ..."

No I don't think free choice is being taken away from the Physician, I am of the view that it is unethical not to continue to see a patient because they decline a single, isolated piece of the healthcare pie based upon their beliefs.

I will agree that if the parent or patient is being consistently unreasonable and/or non compliant with all treatment to the point where the Physician is truly unable to care for them because they are so unreasonable and/or non compliant then that is different.

I've been seeing my GP for nearly 30 years, I didn't fill a prescription she gave me once, so should she terminate me from her practice?

[ERDoc]

Again, I'm pressed for time, but your Registrar application is in the mail. As for your prescription, there is a difference between you not taking a personal prescription and continuing to treat someone that could be a threat to public health and the public good.

[Kiwiology]

As for your prescription, there is a difference between you not taking a personal prescription and continuing to treat someone that could be a threat to public health and the public good.

Public health is important no arguing it; it was really the first major breakthrough in medicine and had the greatest impact on morbidity and mortality; more than surgery and anaesthesia and infection control combined; sorry Semmelweis, Baron Lister, Davey and Morton I am sure you understand

I hate to say it but this phenomenon seems to only be occurring in the US ... I do not see any of the Royal Colleges of Paediatrics or their equivalent bodies screaming that their Physician members are unhappy about seeing unvaccinated children.

It should be noted for general medical care unlike appears common in the US that internationally children do not see a Consultant Paediatrician they will see a General Practitioner (Family Physician). To see a Paediatrician or paediatric sub-specialist (surgeon, oncologist, psychiatrist etc) you must be referred by your GP as having something paediatrics can offer a specialist service for or opinion on ... and no, those awesome tasting lollipops do not count, bugger, I want to know where they get those, my tax dollars at work!

Does that change anything? No, probably not, but I thought I would add it for reference because it was interesting to note in some Googling that news articles mentioned parents taking their children to a Paediatric practice.

Edited February 20, 2012 by kiwimedic