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The United States is currently experiencing an unprecedented measles epidemic. According to the Centers for Disease Control and Prevention, more than 760 people in 23 states contracted measles this year, "the highest number of cases reported in the United States since 1994 and since measles was declared eliminated in 2000". health crisis, Mother Jones spoke with Sean O'Leary, a physician specializing in infectious diseases in children in Colorado, was, he said, "on the front line" of conversations with parents about vaccines as a former pediatrician in primary care from 1999. He has also conducted research to identify and eliminate barriers to vaccination.
Here, O 'Leary tells us, in his own words, about his experiences: how he has seen parents in recent years expect to collaborate with doctors for the medical care of their children and how this practice could lead to a reduction in the number of vaccinations. What he's talking about is known as "shared decision-making," and research shows that asking open-ended questions such as, "What do you think of Johnny"s shots today? "Is less effective in getting parents to vaccinate their children than" the presumptive approach ", in which the language used assumes that the child will be vaccinated: "Johnny has blows today." While the importance of provider-parent interactions in vaccination rates in the country is not entirely clear, O'Leary argues that almost all physicians are currently dealing with parents who are expecting to participate and to collaborate in the care of their child.
As O 'Leary explains to Mother Jones, he found the difference between the two approaches – and he knows how these conversations can be stressful, even confrontational. But, he says, they are crucial.
When I was first From the general pediatric practice, there was a day when I went to see a child of four or five years old. It was the first time I saw him. But when I went through her chart, I did not see any vaccines.
I thought, "It's weird. They just do not have to have the file. When I entered the room – and I remember the guy – there was this father. It was an engineer. I visited him regularly and then said, "Oh, you know, I did not find any vaccine here. Do you have a copy of the shooting records? "
He said, "Oh, no, we do not vaccinate." And he took out this notebook with Excel spreadsheets. He had graphic paper with his writing. And he had basically done his own analysis of many vaccines.
He tried to convince me that vaccines were not working and that they were a bad idea. And I was completely taken aback. I had been trained at the faculty of medicine and residency to benefit from vaccines and I knew these recommendations came from people who had devoted their lives to studying these things, using the scientific method.
I came out of there shaking, I was so angry.
This was the first example [of an instance where I encountered a parent denying the science of vaccines]. With time, I have certainly softened my approach. And I ended up recognizing that there is a wide range of people around vaccines. The vast majority of parents accept vaccines – you simply say, "This is the time for vaccines," and they receive them. Then there is a percentage of people who just have questions. And then, there are those rabid anti-vaccination parents like this guy.
In my practice, with the infant vaccine series, we always took a presumptive approach: they came in and it went without saying that it was a 2-4-6 month visit. [per the recommended screening and assessment schedule for newborns]. Then the nurse came in and did your injections. And I think that's how many practices worked. We did not even think about it at the time.
I started my medical studies in 1992, then my residency in 1996. Then I became a pediatrician generalist in 1999. At that time, the Internet was becoming more and more a tool of information on health. In the early 2000s, that's when I started to see [misinformation]. It was not just vaccines, but anything. People printed what they found on the Internet.
Once social media platforms became more common, it really fueled this spread of misinformation. It was also around the time when teen vaccines were starting to be used extensively – Tdap, meningococcal vaccine, and then the HPV vaccine. And part of that is perhaps a coincidence, and another part is potentially linked. But that's where you had to talk to the parents and the teenager, "We're going to do these injections today." And that's when I first recognized as a clinician that I will not ask any questions about it. I'm just going to say it because I'm having less resistance when I do it.
The "presumptive" approach is something that many people have already practiced, but for those who are not, we now have evidence that it works. "Shared decision-making "is really about preference-sensitive decisions – places where there is no clear medical treatment, no clear and correct medical decision. For example, to make a decision between open heart surgery or the use of a catheter. But where there is a clear medical indication for an intervention, it is not really an appropriate place for shared decision-making. And vaccines fit perfectly in this space. The benefits of vaccines far outweigh the risks and are in the best interests of the child.
For doctors, discussions with hesitant parents are difficult conversations. A 2011 study found that when pediatricians encountered questions about vaccines in parents, about half said they spent more than 10 minutes. [explaining the science]. In the United States, a healthy child's visit lasts an average of 18 minutes. If we spend more than half of our time talking about what we do in pediatrics, that's really what we're building on evidence, it's a real problem. And as a pediatrician, it is a fairly common phenomenon. The scientific community does not debate whether the benefits of vaccines outweigh the risks. And so, when you have to spend all this time explaining something that should be simple, it can be very frustrating.
And the other important thing is that we have not really learned how to navigate these conversations. You end up in sometimes conflicting or conflicting situations. At the end of the day, many parents agree to be vaccinated, but many still do not.
So, how do you inform each patient about vaccines? In the past, it was based on what some people have called the "information deficit model": you simply provide the facts and assume that human decision-making is rational. And once you have provided the facts, people will make the right decision. But it's clearly a lot more complicated than that.
The work I'm doing involves the use of another technique called "motivational interviewing". The fundamental concept of motivational interviewing is that patients make the decision, that patients change their health behavior, because of their own motives motivations of the doctor. The techniques we focus on are asking open-ended questions, using affirmations, using reflection, asking permission to share, and then offering support for self-reliance. Research shows that this approach can be effective.
In many cases in pediatric medicine and medicine, shared decision making is a very appropriate approach. And I think parents should take that into account. But vaccines are really not one of those situations. The science behind the vaccination schedule is very clear. The best thing for parents to do is vaccinate their child according to the recommended schedule.
By the way, I only saw this family [from 1999] A few more times in the clinic, but a few years later, I saw the father at a street festival in Fort Collins. He was in front of a placard where he praised the theories of the 11 September Holocaust denial conspiracy.
This has been condensed and edited for clarity.
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