In January 2006, Canadian Family Physician published a guide for family doctors that detailed male and female preventive health care checklists.¹ These recently updated checklists² are comprehensive and include notations to help busy practitioners remember to ask about various issues, ranging from flossing to noise control programs and from seat-belt use to nonflammable sleepwear. All well and good.

In 2008, we witnessed an outbreak of mumps, which started in the eastern provinces but quickly spread across the country as students returned home after the college semester ended.⁶ There have been several deaths from tetanus in western Canada, as elderly, unimmunized people tended to their gardens; and although we now have the ability to make inroads in decreasing cervical cancer for our young women, again, the vaccine remains on the shelf for a large number of eligible women. On average each year in Canada, approximately 4000 and 3000 deaths have been reported from influenza and pneumococcal pneumonia, respectively—astounding numbers considering the availability, safety, and low cost of these vaccines.^7,8

As family physicians we are in a unique position. We have the trust of our patients and the advantage of our ongoing relationships. We are the specialists in adult immunization! Whether we are discussing the diphtheria-tetanus-pertussis series for adults, particularly those with infants at home, or the new shingles vaccine for older Canadians, it is our role to educate and to inform so that our patients can make good decisions for themselves. In Canada, immunization is a team sport. Whether vaccination is taking place in public health clinics, school-based programs, pharmacies, patients’ workplaces, or in our offices, the responsibility of education remains in our hands. Our patients need to have our recommendations, and we can share the burden of implementation with the many players in our system. A 2006 survey conducted by the Public Health Agency of Canada found that physician recommendation had a huge effect on patient acceptance of vaccines.¹⁰

In my opinion we can begin to do a better job. One important opportunity would be to move immunization from its current position in the chart to the part of the record that includes allergies and medications. As doctors, we always look at medications to give us a very quick overview of issues, diseases, and likely problems. If we start to evaluate health by including immune status, we will be in a position to make better decisions, to order appropriate tests, and to have more complete preventive assessments. We need to know if our diabetic patient has received the pneumococcal vaccine or not. Measurable outcomes depend on us and our efficiency. We need every patient, not just children, to be up to date and immunized for vaccine-preventable diseases. If we are going to change the focus from treating acute illness to a more long-term preventive strategy, we need a more aggressive approach, ensuring that vaccine-preventable diseases are indeed prevented. Our role as trusted family physicians includes the important task of education. Patients have the right to accept or decline vaccination; our job is to make sure that they understand the effects of that decision. Whether by attending continuing medical education events or through local incentives, such as Ontario’s addition of the pneumococcal vaccination to the compensated Diabetes Patient Care Flow Sheet, we need to look at novel ways of including immunization in our daily conversation.