Parenting Solved

Wakefield and the Fall of the Vaccine-Autism Connection

It’s been a tough week for he anti-vaccine movement.  Mounting evidence of fraudulent manipulation of data by Andrew Wakefield has all but put the light out on the MMR autism connection.  The U.S. Court of Federal Claims put the kibosh on the compensation of thousands of families by the U.S. government when it found no evidence linking vaccines with autism.  And over at Age of Autism, anger is advancing to bargaining and acceptance like the Kubler-Ross progression of a terminally ill patient.  Gone are the glory days of thimerosal.  

And what’s become of the man who started it all?

The emasculated Andy Wakefield, unable to practice medicine in the U.K., has taken safe refuge at the Thoughtful House in Austin where Texas law allows him only to watch patients from a distance, much like a curious nurse’s aide.  Wakefield’s muted existence is a far cry from his heady days in the spotlight when the world believed for a moment that his contrived ideas actually amounted to something.

While I’d like to say that it’s finally over, the vaccine-autism connection was dead before it ever began.

Those still at the party should heed the insight and courage of Alison Singer, executive vice president of Autism Speaks, who recently resigned her post recognizing that the game was finally up.  It’s time to give children with autism the attention and resources they deserve, she noted.  It’s time to move on. 

Effective Doctors Listen - Reflections on The Happy Hospitalist

There was an interesting rant last week at The Happy Hospitalist.  It concerns one doctor’s point of view on listening to patients.  As a patient I wouldn't want this person as my doctor.  As a doctor it’s embarrassing to be reminded of colleagues with such contempt for patients.

Here’s where I agree: Patients don’t know what’s critical and what isn’t.  The parents who come to my clinic with sick kids are desperate to get answers.  Many have been waiting a long time and most arrive with the false belief that they won’t have much time with me.  So the tendency is to want to tell me every little thing, and quickly.  They’ve rehearsed their stories and want to let it all out when they see me.

My job, however, is to control the interview and extract the information that I need while allowing the patient the opportunity to vent their concerns.  In the case of abdominal pain, for example, I have a very systematic interview that I conduct.  When parents want to give me information that I don’t need I’ll let them digress momentarily but then I gently redirect them.  As the interview progresses parents grow more at ease when I showcase a compulsive, thorough evaluation.

As I finish my history, stand up and segue into the exam, I allow parents the opportunity to open up and offer their thoughts and feelings about their child.  And it’s here that I’ve learned some of the most interesting tidbits of information.  It’s this time between the computer and the exam that I’ve learned things that have made all the difference.

The frightening part of The Happy Hospitalist's angry diatribe is the belief that he has it all figured out; the trivial concerns of the patient are simply obstacles to what he needs.  I haven’t figured it all out yet and when I do, I hope I’ll still respect the needs and concerns of those who trust me with their children.