Gerald O'Malley, DO: Why I'm Not Getting the Flu Shot

I’m not getting immunized against the flu. I’m not immunizing my kids either. Sue me.

I’m not a Luddite – I know the science, and I know the statistics, and I know the professional recommendations. My kids have been fully immunized against measles, mumps, rubella, diptheria, varicella, tetanus, and all the other typical childhood diseases. I can explain some of the technical aspects of vaccine preparation. I’m still not snorting the vapor or taking the shot.
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Call it stubborn or call it stupid – I don’t care. I know that there are a lot of physicians that agree with me, but they are afraid that if they refuse the vaccine they will be labeled paranoid or a conspiracy theorist, or they simply don’t want to stand out or be seen as a problem employee or be ridiculed.

I’ve had to sign attestation statements for several of the hospitals in which I work explaining why I’m refusing the flu vaccine. My home base hospital grants me the right to decline the vaccine provided I give them an explanation. The reasoning isn’t terribly important – just so long as they have some kind explanation for the refusal. The last few explanations have implicated the worldwide vaccine-industrial complex and global warming as reasons for my refusal. They don’t seem to care too much.

Some hospitals, on the other hand, care a lot about the reasons why I don’t want to vaccinate myself or my kids. In my opinion, the administrators at some hospitals are intrusive, obnoxious, coercive, and bullying in their insistence that I accept the vaccine. I do a lot of consulting work through the Philadelphia Poison Control Center, and at least one hospital has insisted that since I am a consultant member of the medical staff, I show proof of vaccination or lose medical staff privileges and face being reported to the National Practitioner database. I’ve explained that all my patient interactions involve telephone consults and I never actually set foot in the hospital, and that despite the virulence and general scariness of H1N1, I’m pretty sure that you can’t transmit it over the phone. So far, the secretaries in the medical staff office have granted me an exemption, but I’m pretty sure that when the actual administrators get around to evaluating my telephone – transmission explanation, I’ll be on the receiving end of some e-mail nastygrams.

All this attention on vaccines seems a little forced and staged, doesn’t it? How did the human race survive and prosper for centuries without absorbing a $30 vaccine every year? Is it me, or does anyone else get the distinct impression that someone is making huge bank on this flu hysteria and the concomitant insistence on mandatory vaccinations for everyone?

OK – this year we need to take two different vaccines. What about next year? Will we be required to take three? When will this end?

My colleagues that actually work at the 100 percent mandatory vaccination hospital tell me that their ED census has exploded, the waiting times have tripled, and everyone is frazzled. Would it be worse if there wasn't mandatory vaccination? It's impossible to prove a negative, but I can't imagine that it would be. At my hospital, we don't have mandatory vaccination and the patients are spilling out into the street from the waiting room. Most of them go home. Most of them don't need to be there in the first place. I worked last Thursday and overnight Saturday night and last night and probably 90 percent of the patients I saw had the flu. I think I put two pregnant women on Tamiflu, and the rest went home with Tylenol and orders to rest and drink fluids. Nobody was admitted. The overwhelming majority of patients that I see with the flu (and they ALL have H1N1, according to our ID guy) do perfectly well with supportive care.

How did we get here? Why do doctors beat up on each other to the degree that we do when the external forces decreasing access to care (lawyers, reimbursement, bureaucracy, paperwork) are so oppressive?

I’ve heard all the arguments about how mandatory vaccination is a public health issue, but so is access to care and nobody seems to care a bit about improving that, especially not in Pennsylvania, where we have seen 17 maternity units and 40 healthcare delivery centers close in the past decade, all under the watchful eye of Governor Ed Rendell. In 1992, approximately 60 percent of graduating residents stayed in this state to practice; in 2008 only 20 percent stayed. That is the public health issue that nobody seems interested in talking about.

It’s easier to manipulate a doctor’s conscience and inherent sense of moral goodness (and if that doesn’t work, threaten and coerce) to try to achieve vaccination compliance than it is to lobby the corrupt state and federal legislature to provide the resources to actually deliver health care.

Instead of focusing on me and my declination of the vaccine, why don’t our professional leaders ignore the low-hanging publicity fruit and tackle the hard job of taking the fight to the legislators and improving access to care?

My daughter is home right now. She has H1N1 and has been home since Saturday with fevers and coughing. Forty percent of her school is out sick, and my wife just called to tell me that our son is in the nurses office with a fever, so I guess he will be laid up for the rest of the week. Then he will get better and go back to school and life will return to normal in a few days. My daughter is already over the worst of it and should be back to school tomorrow. Thankfully, my kids’ pediatrician has been in practice almost 40 years and he doesn’t see the need to vaccinate all his patients. At least I won’t need to come up with a creative explanation for him.