Volume 33 • Number 4 • April 2012
If not vaccination, then what?
by David W. Kimberlin, M.D., FAAP
My grandfathers were born in 1889 and 1892, and
my grandmothers in 1901 and 1904. At that time,
families were larger than they are now. My grandfa-
thers had nine and 11 siblings, and my grandmothers
three and five siblings.
Back then, about one in five children died during
the first five years of life, mostly from infectious dis-
eases. These statistics described my family as well:
One grandfather had a sister who died during child-
hood from burns (possibly with related infection),
and one grandmother had a brother who died of
meningitis. It was common for parents to bury at
least one child.
See Vaccination, page 4
The AAP National Nominating Committee
has selected Michael D. Klein, M.D., FAAP,
of Detroit, and James M. Perrin, M.D., FAAP,
of Boston, as candidates for AAP president-elect.
Profiles of Drs. Klein and Perrin and their posi-
tion statements will appear in future issues of
Voting begins Aug. 31 and concludes Oct. 1.
Pediatricians and the Law
from the AAP Committee on Medical Liability
How to end physician-patient relationship legally
and Risk Management
We need to dismiss a family from our prac-
tice because they continually miss
appointments. What steps do we need
to take to do this correctly?
Once a physician-patient relationship has been estab-
lished, the physician is not free to terminate the rela-
tionship at will without formal, written notification to
conform with state law. The physician-patient relation-
ship continues until it is ended by one of the following
• The patient has no need for further care or is for-
mally transferred to another provider.
• The patient terminates the relationship.
• The physician formally and legally terminates the
Failure to implement and document a formal termi-
nation process may constitute patient abandonment
and bring about fines or legal action if the patient is
harmed by the abandonment.
There may be circumstances in which it is deemed
necessary to terminate the physician-patient relation-
ship. Perhaps the patient is noncompliant (i.e., does
not follow the agreed-on course of treatment, fails to
keep appointments, does not share fundamental health
care principles such as the need for preventive medicine
First, attempt to assess the reason(s) for the noncom-
pliance. If you believe that to continue treatment with-
out consistent patient follow-through is likely to increase
the chances of a complication or poor outcome, the
wisest course of action may be to terminate the rela-
Perhaps the parent is unreasonable, demanding,
threatening, verbally abusive or rude. Sometimes, the
physician and parents simply do not get along. Perhaps
a patient routinely fails to pay bills without offering an
explanation or seeking to set up a payment plan. Any
of these problems (and many others) may be sufficient
reason to dismiss a patient from your practice.
Match Day results
The 98.3% fill rate for all pediatrics in the 2012 Main
Pediatrics: percentage of filled
positions continues to grow
Residency Match (an increase from the 2011 fill rate
of 98%) marks a level not surpassed since 1999, when
98.6% of all pediatric positions were filled. Categorical
pediatrics filled 98.7% of all positions, an increase from
last year’s 98.2%. Match Day was March 16.
The continued popularity of pediatrics as a career
choice was demonstrated by U.S. seniors, who filled
70.7% of all offered positions.
Internal Medicine-Pediatrics filled 95% of all offered
positions (compared to 99.2% in 2011); family med-
icine filled 94.6% (compared to 94.4% in 2011); and
internal medicine filled 97.4% (compared to 97.2%
For more information on this year’s match, see the
May issue of AAP News. For detailed data tables, visit
the AAP Division of Workforce and Medical Education
Policy web page, www.aap.org/workforce.
In this issue
Spotlight on child maltreatment, prevention
AAPNewsmarks Child Abuse Prevention Month with three
articles that highlight this growing problem, as well as infor-
mation and resources to help pediatricians educate parents
and others in their communities who care for children.
Pages 5, 6 and 12