"Patients often have health needs that cannot be addressed within the walls of a clinic, and it is the job of the primary care physician to recognize these needs and attempt to effect the change needed to address them," this medical student learned through Baylor's Primary Care Innovation Collaborative.
By Tiana Won
When I was a child, my parents, like most at the time, had me get all my immunizations on schedule before starting school. I didn’t like getting shots, but I didn’t question it. So I was shocked when, as a college intern at the Department of State Health Services, I learned that some parents refuse to vaccinate their children due to a perceived link between immunizations and autism. Prior to my internship, I would not have believed that parents would actually want to limit vaccine requirements and actively work towards such limitations through involvement in organizations such as Parents Requesting Open Vaccine Education (PROVE). I continued to learn more about anti-immunization groups through a course on the history of American medicine, the book Autism’s False Prophets
by Paul Offit, and numerous news articles. Though they may have rare adverse side effects, the benefit of immunizations far outweighs the potential risks.
At the height of my frustration with the idea that parents would fail to protect their children from known infectious diseases based on anecdotal reports rather than scientific evidence, I shadowed my former pediatrician, Dr. Treybig. One of the patients she saw that day was a 12-month old girl due for a number of immunizations. The parents mentioned having heard of a connection between vaccines and autism, and they sought Dr. Treybig’s opinion. Her response combined a gentle understanding of their concern and an unwavering support of immunizations. Furthermore, she informed the parents that the Wakefield study linking autism to immunizations was retracted due to fraudulent evidence. That afternoon, the reassured parents let their daughter get all of the appropriate immunizations. Witnessing this patient encounter restored my faith in primary care physicians’ ability to encourage healthy practices among their patients and act as important players in the fight to separate fact from fallacy in medicine.
Yet after starting medical school, I attended a lecture on human papillomavirus (HPV) and was struck yet again by the number of eligible women who do not receive the full series of immunizations. I grew tense listening to reports of parents avoiding the vaccine out of fear, not of autism but of promiscuity. I felt some relief when a professor suggested that the lower HPV vaccine rate was more likely due to accessibility issues and busy patient schedules than opposition to the vaccine. I began thinking about how I could get involved in ensuring that those who were willing to protect themselves through immunizations had the opportunity to do so.
Not long after, I learned that Baylor’s Primary Care Innovation Collaborative (PCIC) was looking for students who wanted to be involved, and I quickly signed up noting that I was interested in improving HPV vaccination rates. I imagined I would be doing some kind of work in a clinical setting, such as assessing new means of contacting patients about needed vaccines, researching more effective ways to educate them about the importance of immunizations during visits, or coming up with a tool that would enable patients to keep better track of their vaccine history and schedules. Yet when I met with my mentor, Dr. Middleman, who is a professor of pediatrics, she told me about a grant she was working on for a research study that would determine the efficacy of different strategies for increasing immunization rates in schools.
While the research question intrigued me, I wasn’t sure if a school-based study would qualify as a “clinical innovation project” in the PCIC. I voiced my concerns to Baylor’s PCIC coordinator, Amy Cobb, who reassured me that the project was worthwhile and, in her opinion, fit the mission of the PCIC. She also offered to reach out to members of the national PCIC community for feedback. A few days later, we received an e-mail from Dr. David Margolius. Dr. Margolius encouraged us not to limit ourselves by being overly concerned with conforming to an ideal of the “typical” PCIC project. He encouraged us to remember the beauty of primary care as a dynamic field that evolves with patients to address their chief health concerns. With the help of Amy and Dr. Margolius, I realized that primary care innovation projects do not have to fit a specific mold, largely because primary care itself has few clear borders. Patients often have health needs that cannot be addressed within the walls of a clinic, and it is the job of the primary care physician to recognize these needs and attempt to effect the change needed to address them.
Unfortunately, not every parent with questions about the safety of vaccinations has access to a pediatrician like Dr. Treybig with whom they feel comfortable expressing these fears. Studies like Dr. Middleman’s can help identify whom these patients trust to answer such questions and how physicians can more effectively communicate the safety of immunizations. Our research project will not only provide free immunizations to middle school children in Houston, but will also gather data to assess the efficacy of interventions aimed at improving the relationship between the mobile health care team and community members. We hope this data can be used to improve the structure of school-based immunization programs in such a way that parents are more aware of the opportunity, understand vaccines’ importance and commit to having their children immunized.
I am excited about working with Dr. Middleman and her research team to discover new knowledge that may provide insight for more intervention-based projects to increase immunization rates. I’m more excited, however, to be in the company of other medical students and physicians who are not afraid of defying traditional ideas of the physician’s sphere to tackle issues such as immunization compliance. This opportunity to care for patients by reaching out and offering to discuss their health concerns, no matter the topic, is a critical and wonderful aspect of primary care that I hope all medical students have the chance to experience.
Tiana Won is a second-year student at Baylor College of Medicine in Houston, Texas. Aside from her interest in ethics and preventive medicine, she also enjoys kayaking, dancing and exploring new recipes.