>I don't know what your practices are but in my office we make no promises as >to what the future will hold- only discuss what the current practices >(subject to change at any time) are now. My patients are made aware of the >fact that vaccine schedules sometimes change as quickly as over night (like >in the case of rotashield). I WOULD NOT REFUND the cost of administration >since I was paid for work I did, not for work I would do in the future. In >medicine we never make promises about outcomes or about the future... As you (all) develop policies regarding the above question, consider that one of the dynamics that may influence requests for a refunds (for any reason, not just vaccines) is the patients'/parents' perception that the above may be a prevailing physician view of medicine, and is exactly the opposite of why they come in to see you. Requests for refunds may be their way of telling you that they expect a closer link between process and outcomes, and disconnecting the two leaves physicians open to the suspicion of treatment for the physician's sake, not the patient's. No judgmental implication is intended here, not by a long shot. Rather, considering various points of view may reveal that requests for refunds is not a separate issue but just another aspect of a larger, more encompassing issue. There is a strong tendency to label problems according to where they are observable. Hence the description, "refund request problem". Expanding the field of view would reveal that the refund request problem is just one in a larger system of problems. By considering the system of problems and gaining insight at that level, solutions to any one particular problem might be considerably enhanced. As an example, perhaps seeing refund requests in the broader context of relationships (trust, competency, fairness, duty, promises, commitment, etc.) may reveal some insights that, when addressed, would allay patient concerns and blunt their perceived need to "even up" through a request for a refund (or any other like-type request). Or they may be expressing their level of confidence in the system as a whole and perceive any one physician at any one time as representative (deserved or not) of the whole system. Ultimately, a portion of this behavior may be influenced by fear, anxiety or lack of control. The reference to relations and confidence, likewise, is not a judgmental one. Rather, as all physicians are part of a yet larger system (the health care system, such as it is), their individual role or function (and reputation) in that system is invariably affected by the behavior of the system as a whole. As the whole system influences patients'/parents' perceptions, your personal relationship to patients and parents is correspondingly affected. Regardless of your personal values and practices, you may still need to reinforce every one-on-one physician/patient and physician/parent relationship. In the same vein, difficult though it may seem, critically reevaluating current practices may be worth while even if it turns out to be an exercise that confirms your belief in the way you currently approach patients and parents. No ground breaking insights here as far as relationships go, just a suggestion or reminder to see human dynamics within an expanded field of view and to consider various points of view. Best regards, Bill Braun The Health Systems Group Physician Leadership Training Simulation Modeling for Healthcare http://www.hlthsys.com