Vaccination issue illustrates degrees in which doctors can sway decisions
Doctors used to make decisions for their patients routinely. These days many of them give their patients a say, but just how much of a say can vary considerably. Does that make a difference in the care patients receive? Consider an article published in the journal Pediatrics last December analyzing 111 conversations that 16 doctors and nurse practitioners had with parents of children who were due to be vaccinated. While the study was not designed to look at decision-making specifically, it may provide some insights.
All of the healthcare providers in the study surely believed the children should have shots. “There are no known medically acceptable alternatives to the CDC’s routine childhood immunization schedule,” says Dr. Douglas Opel, an assistant professor at the University of Washington School of Medicine and lead author of the study.
True, research associating autism with childhood vaccinations made a big splash when it came out, and many laypeople still believe in those findings. But subsequent research has not found any such link. And according to the Centers for Disease Control and Prevention (CDC), if we stopped vaccinating children, “before long we would see epidemics of diseases that are nearly under control today. More children would get sick and more would die.” In other words, the medical community is united in recommending that children get vaccinated.
Research has shown that when only one medically advisable course of action is available, many doctors — hoping to reduce the chances that patients will choose a medically inadvisable action — simply don’t give patients any real choice about what to do.
It’s not terribly surprising then that about three-quarters of the providers in the study introduced the subject of vaccination in language implying that vaccination was a foregone conclusion — e.g., “We have to do some shots.” Thus, they avoided opening the door for parents to choose not to vaccinate.
But the remaining providers in the study did open that door with language implying that vaccination was not a sure thing — e.g., “What do you want to do about shots?” These providers may have believed very strongly that parents should make their own decisions.
The two approaches yielded very different results. When providers acted like not vaccinating was not even a choice, some parents still said they didn’t want the shots — but far more did so when providers seemed to indicate that that was a viable option.
What happened after parents nixed the shots may also have varied according to how providers viewed their roles. Sometimes providers simply dropped the subject, perhaps because they thought it was the parents’ decision to make. But about half the time providers did not take no for an answer. Apparently, these providers felt a duty to encourage parents to make the medically advisable decision. So they tried to change the naysayers’ minds — e.g., “Your child really needs these shots” — and about half the time their attempts at persuasion were successful.
In this study, then, how much influence parents ended up having on a treatment decision depended a great deal on how much influence the providers chose to give them — with some granting them close to carte blanche, some limiting them as much as possible and some trying to guide without directing. (See main story.)
