Professionalism, fidelity and relationship-preservation: navigating disagreement and frustration in clinical encounters.

In February 2012, The Wall Street Journal summarized cases and research documenting growth in the numbers of physicians who ask families to leave their practices due to parental refusal of vaccines for pediatric patients. (1) Some physicians ask families to leave because they feel that they have a professional obligation to maintain a standard of care that is unattainable when parents refuse vaccines for their children. Others struggle with how to maintain a therapeutic relationship with a child whose parents' health beliefs conflict with vaccine schedule recommendations. Additionally, one social and cultural trend that seems to influence physician-family relationships in these cases is "anti-intellectualism." I consider some important challenges these issues pose for professionalism in the physician-family relationship, and consider a few values helpful in configuring responses to those challenges.