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Original Question

Please read this case study and answer these questions. – Please address the situation Dr. Halamek finds himself in when dealing with the Collins family. Could he have handled his interaction with Ms. Collins over the vaccination issue better? Do you think Dr. Halamek can refuse to treat the Collins’ children if they are not vaccinated? What assistance could or should the health care team have provided to Dr. Halamek before he met with the Collins family? Read this David Halamek, MD, is a new pediatrician in a large children’s ambulatory clinic that includes the full range of health professionals among the clinic’s staff. Because he just became a member of the clinic practice, Dr. Halamek is seeing patients who were new to him or new to the clinic. One of these families is the Collins family, who were making their first visit to Dr. Halamek. There was not much in the background information Dr. Halamek received before he saw the Collins family. He knew there were two children, ages 2 and 4, and that this was a visit for a routine physical for the 4-year-old. He also saw in their materials a recent evaluation from one of the occupational therapists at the clinic regarding the 2-year-old, Mia. The note from the occupational therapist said: “Mia has left hemiparesis resulting from an intracranial hemorrhage secondary to prematurity. She has full PROM and AROM in her left upper extremity, but there is mild to moderate increased tone. She has a well-controlled reach with the left arm, but her hand tends to close before reaching the object she is trying to grasp. She likely needs orthotic intervention to improve manipulation of objects. no records of immunizations for either child. At the outset of the visit, Dr. Halamek asked Mrs. Collins if she could remember the vaccinations her “33 Dr. Halamek also noted that there were son had previously received. She told Dr. Halamek that her son had never received any vaccinations and that she did not plan on ever vaccinating her children because she had heard from several reliable sources that they were the cause of autism. Dr. Halamek informed Mrs. Collins that her views about the vaccinations were based on faulty information. He had encountered parents like Mrs. Collins before, so he had a copy of the now infamous journal article that featured a retraction of previously connection between vaccines and autism. He gave the copy of the article to Mrs. Collins. But Mrs. Collins did not want to discuss it. After moments of frustration and further attempts to convince Mrs. Collins about the importance of immunization for her children and others, Dr. Halamek told Mrs. Collins that he would not be able to treat her children if she was unwilling to agree to the approved immunization schedule. Mrs. Collins picked up Mia, grabbed Todd’s hand, and left the room. One of the other pediatricians and a nurse practitioner were standing in the hallway as Mrs. Collins huffed out of the office. When Dr. Halamek stepped out of the examination room, they inquired what happened. He explained that Mrs. Collins refused to immunize her children. He then said, “I had no choice but to tell her that I couldn’t care for her children under those conditions.” His colleagues looked surprised at Dr. Halamek’s story. The nurse stated, “There are other options, the first of which is to work with the other members of the team in complicated situations like this. We have been working for months with Mrs. Collins to get Mia the services she needs. I am going to worry sick about that little one.” The pediatrician added, “We are all part of a team here, so no one has to or should make decisions alone. We need all the help we can get to resolve stressful situations like this.” Dr. Halamek was not entirely convinced that this was a “team” decision because he felt a personal and professional responsibility to his patients and to other patients in the waiting areas who might be at risk from children who have not been vaccinated.

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