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On disagreeing with patients, particularly Scandinavians
I’ve been thinking more and more about a patient I saw a couple weeks ago. Nothing unusual about him. Healthy young man, routine check-up. What was out of the ordinary? Well, he was seeing me, for the first time, instead of the pediatrician who had cared for him his entire life. Why? His doctor “fired” him. It was not an amicable termination, to say the least. This pediatrician, using the rudest possible language (I have his written notes; I have never seen such unprofessional name-calling in a medical chart) outright refused to have anything more to do with this boy or his family. What prompted such a scorched-earth reaction? Well, the patient was unvaccinated. Now, I know what you’re thinking, but no, he was not unvaccinated per the traditional childhood vaccine schedule – you know, tetanus and measles and chickenpox shots and all that; the patient had gotten all his childhood immunizations perfectly on time as officially recommended, not a single jab even off by a month. Nor was he unvaccinated against Covid; the patient had gotten two Pfizer shots already, without incident, in the office of the very doctor who since fired him. No, the point of invective-spewing contention was the third shot, the booster. Having gotten two Covid shots already, and being in excellent health, the patient and his family declined the booster. So his beloved doctor told him to get the h-e-double-hockey-sticks out of his office and never come back.
I have never fired a patient, though I’ve had a few doozies (if you’re reading this, no, not you, you’re my favorite, don’t tell the others). Part of that is the nature of pediatrics. I imagine if I were an ‘adult’ doctor, I’d have a shorter fuse, and if my middle-aged patients kept chain-smoking Lucky Strikes and guzzling Big Gulps while we went over their latest lipid panel, I’d advise that they find a different internist to ignore. In the world of pediatrics, though, my patient is the child, not their parents. Even if the parents make choices I disagree with, I have never understood why denying care to the child in such a situation would be considered the wise approach.
I also happen to be extremely, er, opinionated. You’d think this would make me more likely to fire patients, but quite the opposite. For instance, I believe letting kids have smartphones is nuts. The only way mine will be able to log on to social media is by climbing over my dead body. Does this mean I would ever fire the majority of my patients, who would only breathe fresh air if that were a bonus feature on TikTok? Of course not. Precisely because I am aware of how far out of the mainstream I feel about this or other issues (*cough* homeschooling *cough*), I try to dial back my intensity when discussing them with patients, because I don’t think most families would get a lot out of a visit with a spittle-flecked madman who tries to forcibly flush their electronics down the office toilet and refuses on principle to fill out school physicals because “organized sports are, like, totally a tool of the patriarchy, man.” So, you see, passionately opinionated, but consequently slow to fire those I disagree with. I mean, this is medicine, not matrimony, you know? I don’t curate a list of “deal-breakers” for my patients like some twentysomething on eHarmony. “Oh no, my three o’clock with ear pain doesn’t adore Francine Rivers? Fired! She’ll have to get some other chump to prescribe amoxicillin for her!” Seriously, who does doctoring like that?
Apparently, some doctors do, so let’s talk boosters. I’ve been outspoken about lockdowns and masks in the past, because childhood development and mental health are my particular soapboxes, and various mandates were involved, and I couldn’t live with myself if I just silently stood by and watched children being forced into speech delays and self-harm. The covid vaccines, though long an object of controversy, are a different kettle of fish. There was no evident developmental or mental health connection, for one, and there were no childhood mandates (at least in our neck of the woods), for another. So I approached covid vaccines for children in my practice in the same manner I approached Minecraft, or unschooling; I wasn’t going to let my personal views on the subject poison any visits or override the values and preferences of the families I saw. I naively thought I could keep my peace in public, for I believed my pediatric colleagues would keep theirs. Families could be trusted to make their own decisions based upon the needs of their children, and nobody would have to be bullied or harassed. So I kept mum. Not anymore. Now that I have learned to my great shock that my fellow local pediatricians are viciously bullying their families on this highly controversial issue, I feel compelled to chime in.
If you are at all familiar with the debates over childhood vaccination in America over the decades, you know of Dr. Paul Offit. He is perhaps the nation’s leading pro-vaccine spokesman, making countless appearances to call out the more vaccine skeptical voices in our communities. Here is a typical pre-Covid example. This is not a man on the fence about childhood vaccinations. You think the modern shot schedule is a little overkill? He thinks it’s barely a good start. In his ideal world, your babies would be getting dozens, if not hundreds, more shots every year, and there would be nothing wrong with that. He is, in short, no sensible vaccine moderate. He is as pro-vaccine as it gets. He has thus, as one would expect, been as enthusiastic about Covid vaccines for children as he has been for all other jabs. Yet – yet! – even he, even this man who has built a sterling international reputation out of vaccine advocacy, recently came out and said he would not advise his college-aged son to get the Covid booster. Here is a very, very pro-Covid vaccine website making peace with his statement. For those of you not in the pediatric medical community, Dr Offit speaking out with even the gentlest skepticism about any vaccine is unthinkable. This is like Hugh Hefner saying he’s not that into blondes. And yet, in Austin, if you share the renowned Dr Offit’s minimal doubts, at least one doctor is going to yell at you and kick you out of his practice.
Dr. Offit is not alone. The World Health Organization – not exactly a hotbed of anti-vaccine conspiracy theories – has recently stated there’s no evidence healthy kids need Covid boosters. The United Kingdom recommends against boosters for most healthy children under 15. Sweden doesn’t vaccine any children under 12 and opposes boosters for teenagers. Norway doesn’t give healthy children boosters. Denmark doesn’t give healthy children boosters. It’s not just Brits and Scandinavians; Japan doesn’t boost children, either. We could probably add other countries to the list, I just got tired of googling. Why do so many experts, in so many different countries, hesitate to boost children? The short version is that they do not feel the benefits outweigh the risks. A deeper dive into the issue, from a very respectable mainstream journalist, can be found here.
The point of this post, however, is not to debate whether Covid boosters are safe and necessary for children. The point is to demonstrate that such a debate exists. It is not some outlandish anti-vaxxer conspiracy theory. In fact, outside of the US, it may even be fair to say the mainstream, centrist position at this time is against boosters for children. To fire a patient because they side with Dr. Paul Offit, the WHO, and the public health establishment of the world’s most advanced nations, instead of with you? That just ain’t right.
“For this is the message that you have heard from the beginning, that we should love one another.” I dare not speak for my colleagues, this is a private blog and I don’t want the mob coming for them, but the main reason I was drawn to my practice was that its founders were not afraid to profess that we all strive to follow in the footsteps of a far greater Physician than ourselves. I do not want to call down hatred towards the local offices who are firing patients for not consenting to controversial vaccines; those doctors are far from the only people who have been ‘broken’ by the stress of Covid, and I can only hope they come to find some peace. I simply want to put this message out to all our patients, and all the families in our community: you are welcome here. If you are pro-booster, if you are anti-booster, if you haven’t made up your mind, if you just want everyone to stop talking about it and move on already, it doesn’t matter. The job market is messed up enough as it is already; when it comes to this neighborhood pediatrician, you are most definitely not fired.