A mom I know politely declined the HPV vaccine for her pre-teen daughter, saying that she was worried about vaccine safety.  When her daughter and the pediatrician were alone together in the exam room, the pediatrician told the daughter, “Don’t worry, I’ll make sure you get it before you go to college.”  The preteen, who wasn’t sure she wanted the vaccine, told her mother the pediatrician’s plan.  Irate, the  mom promptly fired her pediatrician and called me for a referral to a new doctor.

This mom is not alone. Most parents are refusing the HPV vaccine.  According to CDC data from 2011, only 35% of girls and 1% of boys completed all three doses of the HPV vaccination.  53% of girls received at least one dose.  Even families whose children are otherwise fully vaccinated are saying “no” to the HPV vaccine.     By comparison, 78% of teens received the Tdap vaccine against tetanus, diphtheria and pertussis, and 71% received the meningitis vaccine.

HPVWhy are so many parents saying “no” to the HPV vaccine?  A study in the journal Pediatrics tried to answer this question, and here’s what they came up with.

“The consistent 11% to 14% of parents who gave the main answer ‘Not sexually active’ illustrates that parents mistakenly perceive this vaccine is related to and necessary only if there is current sexual activity. Another consistent response, given by 14% to 17% of parents across the 3 years studied, was that the HPV is ‘Not needed or not necessary,’ despite the high prevalence rates of HPV infection and of the infection’s dire consequences suffered later in life. Also troubling was the dramatic rise over the 3 years in safety concerns about HPV, which increased from 4.5% to 16.4% of parents over the 3-year period. This increase in safety concerns, which coincided with a decreased prominence of “not recommended” as a reason not to get HPV, may imply decreased parental reliance on clinician recommendations for HPV.

In other words, parent’s don’t trust their pediatricians any more, at least when it comes to the HPV vaccine.  I’ve spent several years talking to parents about this issue, and I think it’s about something more than just the HPV vaccine, something that’s very hard to study.  I think the real issue is that parents are feeling loss of their parental autonomy.  They are getting kicked out of their child’s exam room at pediatric check-ups often when their kids are only 11 or 12 years old, and they worry about the healthcare provided behind closed doors.  Our government, also, struggles to balance parental autonomy while still providing tweens and teens full access to confidential health care.  In some states teens actually have to sign a release form before parents can view their medical records, yet these same teens need parental permission to go on a school field trip.  A growing number of public schools now have on-campus health clinics that provide convenient, necessary health care, yet many parents just don’t like the idea of kids getting health care without their knowledge.  Even when parents agree with the care provided, they feel like someone else is saying, “I know what is best for your child, you don’t.”

 

Do you get nervous about leaving your tween or teen alone in an exam room without you?  Does your child feel uncomfortable without you there?  If so, you need a new doctor.  Every family needs a pediatrician they can trust, someone with whom you really want your child to develop a private, confidential relationship.  If you have concerns about vaccine safety, you need a doctor that will spend the time really listening to what you have heard and provide you with their best professional response to that information.  If you worry about values, find a pediatrician who shares those values.

As for the HPV vaccine, I am personally quite convinced of its safety, and I don’t feel the safety research was influenced by potential financial gains for the pharmaceutical industry.    Stay tuned next Monday for my post on the very sad reality of HPV and how this virus is infecting our children at frightening rates, even without sexual contact.

The mom in the story at the beginning of this article told me she wanted her daughter to have the HPV vaccine, but she needed a pediatrician she could trust.  She fired her pediatrician because the doctor disrespected her as a mother, not because she doubted the doctor’s medical knowledge.  The child in this story is the lucky one, because ultimately she got a new doctor and good health care.  I know of other teens who simply aren’t taken to check-ups because their parents fear what will happen behind closed doors and they worry about leaving a pediatrician who they’ve otherwise liked and trusted since their kids were newborns.  If you feel this way, it’s time to find a new doctor.

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Update, 28-April-2013

Do Adolescents Need Privacy With Their Pediatrician?

In the above post I’ve suggested that the HPV vaccine threatens parental autonomy, and this issue may contribute to the low HPV vaccination rate.  I’ve never seen anyone else write on this issue, yet parents bring it up to me all the time.  I felt it was time to bring this issue to public discussion.  Thank you to so many of you that took the time to contribute your honest comments.

I’m a hospital-based pediatrician, so I don’t have the same close relationship with families that primary care pediatricians enjoy.  Regarding the HPV vaccine debate, I offer a different perspective—I ask every one of my patients who their pediatrician is and if their vaccines are up to date.  I find most families enjoy good relationships with their pediatricians.  Yet every shift I work I meet families who are frustrated with their relationship with their primary care physician, and families who choose not to vaccinate.  The HPV vaccine is the most controversial.  Families ask me for my opinion on this vaccine very regularly—even if they came to the ER with a broken arm, they are often interested in a second opinion on the HPV vaccine.

Should teens be permitted to get the HPV vaccine without parental consent?  Should a pediatrician counsel a teen about this vaccine without a parent or guardian present?  This is a highly controversial issue, and I have no clear answer.  I do feel that pediatricians should highly respect that values and opinions of each parent.  Most do.

It is my hope that all parents will find a pediatrician they trust enough to see their teens privately.  Teens need this privacy to ask questions they might be embarrassed to ask in front of parents.  I’ve had many frightened teens confess to drug use once their parents were out of the room.

When necessary, I do ask minors if they would like to excuse their parent from the exam room.  Only once did I have a parent decline to leave, and I did not make her go.  Twice I have had parents leave before their child even answered the question, only to have the crying, frightened patient ask me to bring their parent back into the exam room.  Of course I brought them back.

As a parent, it is your responsibility to find a pediatrician you are comfortable leaving your child alone with, someone you trust to respect your parental opinions and autonomy.  Most families do find a pediatrician they trust, and I find that most pediatricians do an excellent job respecting parental opinions.  The pediatrician in the story at the beginning of this post is an exception.  Most are much more respectful of parental opinion.

Yet so often I have parents that tell me they just don’t trust their pediatrician to counsel their child alone, especially about the HPV vaccine and issues related to sexuality.  They otherwise have always loved and trusted their pediatrician since their child was an infant, and they don’t really want to leave the practice.  I’ve even had people tell me they stopped bringing their child for well-child check-ups over this issue.  I find this very sad.  If you can’t trust your pediatrician enough to leave your child alone with them, talk about it with your pediatrician.  If you still don’t trust them, find a new pediatrician.