The Doctor Is Out -- to You

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No Longer Welcome

Fox flinched when she got to this part of the waiver: "I know that failure to follow the recommendations about vaccination may endanger the health or life of my child and others that my child might come in contact with." Says Fox, "I really disagree with that statement. There's gathering evidence that giving the vaccine creates more harm than not giving it."

When she returned a few hours later to pick up some documents she had asked the doctor to fill out, says Fox, "The office manager said [the pediatrician] would have no choice but to discharge me." The pediatrician, Lara Azzi, wouldn't comment except to refer me to the Web sites of the American Academy of Pediatrics and the CDC.

Azzi was apparently acting in accordance with the academy's guidelines, which state that "when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice." Fox says she's currently in the process of checking out a pediatrician whom she understands to be more sympathetic to her concerns about vaccination.

Bad Business

And what about the business implications for pediatricians giving the boot to an apparently growing group of parents? Douglas Diekema, a Seattle pediatrician who authored the academy's guidelines on handling anti-vaccination parents, says that so far "The numbers are small enough that it has little impact on physicians."

But longer term, he argues that physicians who refuse to treat objecting patients may actually save money. "These [anti-vaccination] families typically take a lot of time, and that time is not reimbursable. You're spending lots of time trying to convince them [to vaccinate], and you're losing money. You get the same amount of money if you spend 30 minutes as if you spend 10."

While he didn't say it, the situation is actually worse than that for pediatricians, since they not only spend more time with such parents but lose out on the revenues from the vaccines that would have been administered. It sounds like a business owner's worst fears: customers who don't want to buy from one of the owner's core product lines, and then depart in bad spirits.

David E. Gumpert covers business/health issues and also writes the biweekly What Entrepreneurs Need to Know column.