Enough people have written about vaccines that I didn’t think I could add much to the discussion. What does fascinate me, though, is what you think about authority. I have read several articles about practices that refuse to see people who do not vaccinate their children.

This leads to the question of authority and how the wielding of authority affects what we do, and the levels of authority we rely on in our daily practice. Also how our granted authority often runs up against the patient centeredness we are all supposed to focus on.

The government imposes its authority on us by making us take CME (on child abuse, for example). As licensed physicians, we have a great deal of authority. We order tests, spend thousands of dollars, and can give or deny relief of pain with the stroke of a pen. We rely on patients to tell us the truth, and often distrust what we are told. We even have guidelines on when to not believe the patients.

Where do we draw the line between our authority and patients’ right to determine their own care? What happens when our misunderstanding or misinterpretation of our own authority leads to less than optimal care of the patient?

What do we do when the patient says only 10 pills a day provide relief, but the “guidelines” allow only eight? When a family is convinced that vaccines are bad, or even are not willing to accept the risk level certain vaccines do bring, are we right to refuse to treat them or their children?

When do we have the right to incarcerate or hospitalize a patient when they are in need of either? When do we have the right to take children away from their parents for not giving care we feel is necessary?

What about our personal beliefs that we bring into the exam room? If I am religious and do not personally accept abortion as a choice, am I right to not offer it as an alternative to an unexpected pregnancy, refer the patient to others, or offer it, even though it would never be a personal choice? What about birth control? If I am offended by smokers, can I refuse to see smokers? Where do we draw the line?

I ask you to answer these questions for me. Offer me your opinion. I have mine, but where is the evidence-based decision tree that will answer these questions? When does our belief allow us to deny care because the patient doesn’t agree with our belief?

Tell me three simple rules I can follow!