In a paper in Health Affairs last year, Alison Buttenheim, PhD, MBA, from the University of Pennsylvania School of Nursing in Philadelphia, and coauthors concluded that California’s mandatory counseling approach worked. Increasing “the opportunity cost of vaccine exemptions” by requiring the signature of a healthcare provider did reduce these opt-outs, they wrote. Buttenheim told Medscape Medical News that clinicians face challenges in working with parents who have concerns about vaccines. This is only one topic that may be covered in short visit. Parents may notice physicians getting impatient due to time constraints and misinterpret it as a dismissive attitude about…