Medical Rant - skip entry if these bore you

I know that the way I look at the world, and my opinions, are not the only way to look at the world. That as a doctor, coming from a medical background, it is important I don't get stuck necessarily on what I have been taught, but that I must be willing to look at a problem from somebody else's view point, and respect their choices, even if I feel that it is not necessarily the safest way to tackle a problem. With adults, for the most part, I have never found that to be a problem (with the exception perhaps with psychiatric problems when it can be difficult to distinguish between illness and a pts wishes). I accept that there are alternatives to the service I offer, and that none of us holds all the keys.

However in the world of paediatric medicine, where the pt is not the one choosing their treatment, I have to wonder, where do we draw the line? Where does something change from being a difference of opinion, and become neglect or abuse? At what point does a parent's refusal to believe something a medical doctor tells them, and refuse to treat their child accordingly, change from being quirky to criminal?

For example, to choose a hot and often emotive topic, when a parent chooses not to immunise their children, they are imposing on to their children their own specific belief, that is not in keeping with the majority of the medical community. We see these parents, primarily as quirky. For whatever reason, they have chosen to believe people who see immunisations (and usually they argue the preservatives) as incredibly dangerous, even damaging to children. Could I say with 100% certainty that an immunisation will not harm a child? No, I can't. What I can say is that in not being immunised, a child is being left at risk of a preventable and dangerous disease. If you looked through textbooks, and saw the side-effects and mortality of the diseases we immunise against, you might understand you are subjecting your child to a greater potential risk from the diseases, then the potential risk from the immunisations. HOWEVER, having said that, the parents who choose not to immunise, generally are doing it because they absolutely love their children and feel that they are doing the best thing for them. They are good parents, who feel they have legitimate reasons for feeling the way they do about immunisations. And am I necessarily right? No. These parents definately fall into the "difference of opinion" catergory. To be honest the thing that distresses me is that these parents are relying on what we call "herd immunity". That is the theory that if enough people in the community are immunised, than the chances of exposure to the disease is very low, therefore their child doesn't need to be immunised. In other words, they are letting everyone else's children take the risk of immunisation for their child. The problem is if enough people think this way, the 'herd immunity" drops and then we have outbreaks of dangerous diseases, that should not have happened.

[I think after antibiotics, immunisations have been one of the greatest lifesaving advances of medicine. I want to say right here and now, I definately support immunisation. However I also support that if a parent has been well informed and has performed a well rounded research of the issues (that is to say they have read literature from both sides of the argument), that they are their child's advocate and they have the right to not immunise their child. I respect and support parents who think about their children's health, and are doing their best to make what they perceive as the right decision for their children. I would rather have a well informed parent disagreeing with me, then an uninformed one agreeing with me (unless I was really tired and having a bad day), I like people who think.]

Then there are parents who's children have potentially dangerous conditions, who refuse to accept that their child has the condition and refuse to treat it appropriately as directed by specialists. The question is, is this a difference of opinion? Or is it criminally negligent (after all some people may argue not immunising is refusing to treat for a potentially dangerous condition)? Are these kind of parents doing this because they love their child or because they love the idea of having a normal child? I am not a parent. I don't know what it is like. I don't know what these parents have been through. I don't know how I would react were I in their situation. But is frustrating as a doctor, to see a sick child, with a treatable medical illness, not being treated, and having further potentially dangerous events.

So endeth my rant.

Good news is I'm on 6 days off and I'm in a better mood today.