Dr. Erin A. Flanagan-Klygis

"I think it speaks to a level of frustration among pediatricians," said lead author Erin A. Flanagan-Klygis, a pediatrician and ethicist who practices at Rush Children's Hospital in Chicago.
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Flanagan-Klygis noted that her study was of attitudes toward vaccine refusal, not of physician behavior, so it remains unclear how many pediatricians have actually dismissed patients.

Dr Erin Flanagan-Klygis, a pediatrician at Chicago's Rush Medical College and the lead author of the paper, said her team was taken aback by the response."We did not expect this high a number," she said.
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Doctors are the only ones who can counter the misinformation, says Dr Flanagan-Klygis.But she hesitates to condemn doctors who 'fire' patients, saying "[Dismissal] is one way pediatricians express their frustration with that situation."She has never dismissed a family herself, and neither have her two co-authors."When the patient is gone, they are gone."

"I think it speaks to a level of frustration among pediatricians," said lead author Erin A. Flanagan-Klygis, a pediatrician and ethicist who practices at Rush Children's Hospital in Chicago.
...
Flanagan-Klygis noted that her study was of attitudes toward vaccine refusal, not of physician behavior, so it remains unclear how many pediatricians have actually dismissed patients.Several pediatricians said they had done so, not just for refusing vaccines, but when it was clear that trust had irretrievably broken down.

Termination, a touchy subject in medicine, is seen as particularly problematic in pediatrics because of the fear that helpless children may be deprived of care.Doctors are permitted to sever the relationship, according to the code of ethics promulgated by the American Medical Association, only after giving a patient sufficient notice and as long as other care is available.

"One of the reasons I think we haven't heard more from pediatricians is that [firing a patient] is not seen as a good thing to do," Flanagan-Klygis said.
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Flanagan-Klygis said that her interest in vaccine refusal was sparked by the two years she spent working in a private practice in suburban Chicago.

"This came up frequently," she said.One day she asked a family to bring her all the anti-immunization information on which they were relying.She said she sat down and read the books and scrolled through the Web sites."I was blown away by how false it was," she recalled.

Flanagan-Klygis said she agreed to have a series of meetings with the parents to discuss their concerns and referred them to reputable sources of medical information.

"The upshot was that over a period of six months we talked about it and I told them I really felt strongly about vaccines," she said.Ultimately they worked out a compromise: a revised schedule of shots.

"By entering a dialogue, you allow parents to feel they're being respected," she said."But what I did takes a lot of time and resources that practices probably don't have."Nor, she added, are insurance companies likely to pay for such appointments.

Erin Flanagan-Klygis, the study's lead author and a pediatrician at Rush Children's Hospital in Chicago, has run into parents who reject vaccinations--but, she says, "I never have actually dismissed a family."She'd rather talk it out.