Practice dilemma - Mother's doubt over MMR

The dilemma: A mother brings her toddler into surgery because she wants your advice. She has been sent a reminder from the surgery about her daughter's MMR vaccine and, knowing you have a young child yourself, she wants your opinion about the vaccine. She has read conflicting reports about the MMR vaccine and most of her friends at the playgroup have not had their children vaccinated. She wants you to tell her whether or not her daughter should receive the vaccine. What should you tell her?

A mother is concerned about giving her daughter the MMR vaccine (Photograph: SPL)

A GP's view: Dr Alison Glenesk is a GP trainer in Aberdeen
It is always very frustrating when patients choose to believe isolated horror stories rather than scientific fact, so it is encouraging that this lady has gone in to the surgery to discuss her child's immunisation.

Before baffling her with scientific data, it is important to find out what she already knows - or believes.

Many people still think there may be some validity in the original and flawed 1998 study of 12 children with autism and bowel problems, from which the link between autism and MMR was first mooted.

If so, explain that there have been several well-conducted large trials since then which have shown no such link and that even the author has now retracted the study.

Also, why have her friends decided against immunisation? Many parents feel that, while there is still some doubt in their mind, it is better to avoid immunisation.

You have to anticipate this line of thought, and explain that this is not a decision to be taken lightly and it deserves serious consideration.

We know that there was a marked fall in MMR uptake in the early 2000s, with a subsequent increase in measles cases. Every unimmunised child weakens herd immunity.

If the mother is still unsure, give her some written material, and invite her to come back to the surgery to see yourself or the health visitor. However strongly we may feel about the subject, it is ultimately the parent's decision.

Do you tell her whether your own child has been immunised? That depends how well you know her and what your own decision was.

A medico-legal opinion: Dr Richard Stacey is a medico-legal adviser for the Medical Protection Society
On the background of the significant media attention that has surrounded the MMR vaccination, it is understandable that parents may feel daunted at the prospect of deciding whether or not to consent to the vaccination of their child.

In this scenario the mother appears to have chosen to consult you in particular on the basis that you have a young child, and that you are likely to have recently had to make the same choice about the MMR vaccination in the role of a parent.

The mother is asking you to tell her whether or not her daughter should receive the vaccine - this is perhaps a reflection of her uncertainty manifesting itself in an attempt to transfer the responsibility of the decision to you.

It is reasonable to assume that the daughter in this scenario is not Gillick competent and that the mother holds parental responsibility.

You should therefore explain in an empathic way that you are unable to make the decision for her about whether or not her daughter should receive the MMR vaccination, but you will be able to provide information which can assist her decision-making.

You should then go on to explain, in a factual and objective way, the risks and benefits of both having the MMR vaccination and remaining unvaccinated.

In the circumstances it would be helpful to provide the mother with some written information about the MMR vaccine, suggest that she discusses the matter with her partner if possible and have a further period of reflection before making her final decision.

A patient's view: Antony Chuter is an expert patient
This is an interesting dilemma and a very important one for GPs to consider.

Even with all the evidence in the public domain, some parents are still concerned and fearful about their children receiving the MMR vaccine.

This parent clearly needs time and sensitivity as they are experiencing fear.

The GP could discuss the parent's feelings and anxieties but needs to stress that measles, mumps and rubella can be extremely dangerous diseases, not just for their child but also for their child's siblings and friends.

The GP could also talk about the 'media scare' surrounding MMR and tell the parents that there is no evidence to support any connection between MMR and autism; they need to bring the evidence to life in a way which dispels any fears. It would be useful for the GP to discuss research they had read and weighed up themselves.

Hopefully the GP will be able to help this parent understand that the MMR is a safe and necessary vaccine for children.

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