"Altering a diagnosis based on vaccination status is completely different."
You really haven't thought this through. If I'm going to dx measles in a kid with a rash until I find out he has received his MMR shots in which case I dx roseola then I have *altered* my dx based on vax status. Now, you might say "but that's never ever happened" but you've already admitted that drs use vax status to ddx. So either the vax status is used or it isn't. If yes, then the term "alter" is correct. There may be other factors but, ceteris paribus, vax status is used in marginal cases to alter the dx.
Climate Change, page-410
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