Elsewhere in this issue, Flanagan-Klygis and colleagues1 report on a survey of pediatrician attitudes about terminating the physician-patient relationship when families refuse some or all immunizations for their child. The results are interesting if not surprising. Thirty-nine percent of pediatricians said they would dismiss families who refused all vaccines; 28% would dismiss families who refused select vaccines or delayed vaccine administration. There was no difference between pediatricians who elected to end a relationship with the patient (dismissers) vs continuing care (nondismissers) based on physician age, sex, or number of years in practice. How representative are these findings? Although the survey was mailed to 1004 randomly selected members of the American Academy of Pediatrics (Elk Grove Village, Ill), the eligible responders (those who administered vaccines) numbered only 302. No mention is made of the geographic distribution of respondents or any statistical differences based on the family’s insurance or socioeconomic status. In the introduction, the authors do not appear to be neutral about this issue. Emotional energy is conveyed by using such words and phrases as “parents now aggressively question . . . ,” “scrutiny,” “tension,” and “ . . . may view parental challenges as threats to their integrity.” One introductory comment was especially interesting. “In our experience, when a parent refuses 1, some, or all vaccines, the relationship between that pediatrician and parent weakens.”
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