Immediate Past President, Texas Pediatric Society
Member, TMA's Be Wise Immunize Advisory Panel
A couple of years ago, this was the phrase that my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself that it was a harsh but accurate assessment of my performance. And, I was certainly motivated to practice on my own so that the next time, things would be different.
That same phrase came to mind as I read through an alarming article of interest to physicians. The article, published in Cancer Epidemiology, Biomarkers & Prevention is titled “Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey.”
Bottom line: Physicians (primarily pediatricians and family physicians) do poorly in providing the human papillomavirus (HPV) vaccine to patients.
Another source, the most recent National Immunization Survey-Teen for the year 2014, reports another alarming trend. The survey shows the number of patients who start the shots — and also complete them — lags far behind what it should be. (The HPV vaccine is given as a series of shots.)
So, it came as no surprise to me that the first article clearly showed what I have suspected for some time and which has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11-12-year-old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to us physicians!
The article describes findings from an online survey sent to 2,368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of four criteria: endorsement (how strongly they recommend the vaccine); timeliness (whether they recommend it at 11-12 years of age, which is the most beneficial age); consistency (recommending it routinely instead of “risk-based,” primarily to patients the physician believes might be at higher risk for HPV); and urgency (whether the physician recommend the patient receive the vaccination that day). More than a quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported they did not recommend it be given at 11-12 years of age. Amazingly, 59 percent said they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half the respondents recommended giving the vaccine then and there, while the doctor discussed the HPV vaccine with the patient and parent. And these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.
Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. Physicians who can’t communicate the importance of this cancer-preventing vaccine in turn fail to recommend it, which is so important to protect our patients. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we physicians can fix what it wrong with us: Only we can reverse this epic failure!