Punishing non-vaccinators isn't the answer

A resident sent me this article a few days ago and asked for my opinion:

http://www.medscape.com/viewarticle/812130

(apparently this is turning into a regular occurence!)

If you don't have Medscape access, it's basically calling for unvaccinators to be liable if they, or their unvaccinated child, makes someone ill.  While I am strongly in favor of vaccinations (and have written about my ire re: influenza myths before), I fear that this stance may be taking things too far.  Here's what I wrote back:

Vaccination is a victim of its own success; because we rarely see measles, or mumps, or polio in the US anymore, it doesn’t feel like a real risk to many people.  Compare that to the 1960s, when millions of children were in iron lungs fighting for their lives with polio – and people lined up with their children for hours for Dr. Salk’s then-experimental polio vaccine!  

I’m a little uncomfortable with the idea of punishing non-vaccinators.  Most of these non-vaccinators want to do what is right for themselves and their families, and they’re confused about the mixed messages that they're hearing about vaccine safety.  They've been put in a very difficult spot by Jenny McCarthy,  the now discredited Andrew Wakefield, and other villains of the anti-vaccine crusade.  Given that most of the diseases that we vaccinate against are rarely seen, I can see why someone would decide to “play it safe” by avoiding the risks that they have heard so much about when the risk of disease (“perceived susceptibility”according to the Health Belief Model) is very low. 

Remember, most people are rational actors – they make choices that make sense according to their knowledge, beliefs, and surrounding social norms.  Punishing people who don’t have medical degrees and have done their best to choose wisely for themselves and their families with these confusing, contradictory viewpoints will not help increase vaccination rates.
 

What would help, in my humble opinion, is1) publicizing outbreaks of these diseases in the world and in the US - when’s the last time that you heard about the pertussis outbreak in the US, for example, and how it’s killing infants?  why isn’t this front page news???  or the poliooutbreak in Syria?  some vivid pictures and stats would help put these diseases back into the public’s consciousness.
2) having a greater number of intelligent voices decrying Ms. McCarthy, Wakefield, etc.  they are using all of their energy to denounce vaccination, while docs have to divide their energy among countless issues in our office.  We need some public personas to publicly shift the debate.

 I'm not convinced that the blame game is going to solve undervaccination in the US.

EHRs are tools, not solutions

Yesterday, one of the residents in my program sent me an e-mail with this link:

Residents Skip Lectures to Catch up on Electronic Health Record (EHR) Charting
http://www.medscape.com/viewarticle/812566?nlid=36143_589&src=wnl_edit_medn_fmed&spon=34

Here is my response to her:

EHRs by themselves can’t make offices more efficient and often have the converse effect, like we are experiencing here.  As long as EHRs are used as data repositories and nothing more, they offer little advantage over dictating (though I, having mostly grown up with EHR, am far more efficient on EHR – even a bad one like ours – than dictating).

The only way EHRs make offices work better is when offices transform their practice around FULLY FUNCTIONAL systems.

What is a fully functional EHR?  One integrated with an automatic patient history program like Instant Medical History (http://www.medicalhistory.com/home/index.asp); a patient portal allowing e-visits and easy, asynchronous dr-pt communication; and the ability to easily create and maintain patient registries.  Along with a modern office workflow that emphasizes teamwork with a family doc leading nurses, MAs, pharmacists, and physician extenders, EHRs can then make doctor’s and patient’s lives better.  Under this model, docs only see patients for about 50% of the day, leaving the rest of the day to do e-visits, connect and coordinate care with patients using the patient portal, and take care of refills and other paperwork.

But a system without those essential components, plunked into an office still operating with mid-20^th century processes?  Disaster.  

EHRs are not a magic solution in and of themselves.  They are a tool to help us realize that better vision of 21^st century patient-centered care.

If you can find this book online or in the library, it is worth a read – even if you just read the speech about “Dr. Olderway” and “Dr. Youngerway”:

http://www.amazon.com/Escape-Fire-Designs-Future-ebook/dp/B008NBZ972/ref=sr_1_3?ie=UTF8&qid=1382468338&sr=8-3&keywords=escape+fire

I am excited to see your interest growing re: systems of care.  Our specialty needs people who are unafraid to challenge the status quo!

Jen

And that's all I have to say about that.