Physicians did not score as well on “characteristics that are important not just in vaccination risk/benefit communications, but in communications with families in general,” she said. These included introducing themselves and welcoming the mother, expressing interest in the mother, asking open-ended questions, and encouraging questions from the mother. Scores also were lower in checking for the mother's understanding, validating the importance of her concerns, assessing the mother's knowledge about vaccines, and summarizing at the end of the visit.

Among the four physicians who were recorded, only three discussed the risks and benefits of vaccines, and only two presented scientific evidence to refute the mother's claims that MMR causes autism or that thimerosal is dangerous.

Two referred mothers to the AAP and CDC Web sites for more information, and two offered to delay some vaccines—a strategy recommended by the AAP when dealing with reluctant parents. None explored cost as a potential barrier to immunization.

Two gave the mothers inaccurate information. One said he would have to contact Child Protective Services if the mother refused to vaccinate her child. The other said that the child could not attend public school unless immunized, but Kentucky allows religious exemptions.

“The plus side is that none of these physicians refused to care for this family if the mother refused immunizations, and [all] talked about [vaccine refusal] being addressed at future visits,” Dr. Bryant said.