Pediatrician woes!

[AnnDMFT]

Hello!  I'm sure this has been asked on here before but how do you handle doctors who aren't supportive of keeping boys intact and who have no knowledge about foreskin and the natural development of foreskin?

Is is something you deal with on a case by case basis or have you made your point "loud and clear" from the beginning of your relationship with the doctor?  I haven't had any horror stories or anything, just some judgemental remarks from other docs.  And, my kids' pediatrician exhibited her lack of education at my sons' 1 year WCC when she said that she likes to try to retract boys' foreskins when they turn 5 and told me that she still recommends circ'ing because it is more hygenic. 

As we all know, docs don't take well to being told what to do and have their judgment questioned.  I fear that if I'm too "bold" with her that it will affect my children's care.  I would love to try to find an intact friendly pediatrician and am willing to search for one but I think it'll be the same thing wherever I go around here.  (I live in Indiana.  Circ. central)

Other than that, she is an excellent pediatrician and my daughter (4 years old) has a rare autoimmune disorder that I don't particularly want to "train" another doctor in either.  So, I feel at this point, my best option it to just develop a trusting relationship with her and hope for the best....

I don't trust her with my son's penis and I seriously think I'm more educated about foreskin than she is based off of some of the remarks she made at our last visit.  (Not trying to sound cocky but I've done a lot of research on this for this very reason). 

Any words of advice for how you handled a judgmental and uneducated doctor? 

[Pirogi]

No experience, but if it were me, I would just simply not allow her to see or touch my son's healthy penis.  This would be the path of least resistance that would keep your son safe.

If you feel like trying to educate her, there are many threads here about ways to inform a doctor of harmful or outdated practices and beliefs.  I believe there is even a lawyer who will help you send a letter to the practitioner outlining the legal implications of improper care.  But, this may set you up for an adversarial relationship.

Hope others will chime in here.

[AnnDMFT]

I would love for docs not to even look at his penis.  That's just something that is done at WCC's usually, it even was with my daughter though during my daughter's WCC's as an infant, she would just peel her diaper down and look and peel it right back up.  With my son, she has not fully retracted him but has pulled back on his foreskin and this makes me incredibly uncomfortable.

I like how you worded it: "setting yourself for an adversarial relationship."  That's my fear. 

I guess I want to know how I can approach her without offending her and what could I say to her that won't make it sound "I don't trust you with my son's penis care because I think you are a moron who doesn't know anything about foreskin." 

[outlier]

I'm still working up the courage to have a similar conversation with our pediatrician.  When I do, I intend to say something like, "I understand you have to take the diaper off to check his testicles and make sure everything looks okay in there.  I'm fine with that.  However, when it comes to his penis, all the research I've done says not to retract/push back/mess with his foreskin at all.  Can we agree that you won't manipulate his foreskin at all during checks?"  Once I get her to agree to this, I'll ask if I should remind her of this at all future appointments.  I think you're less likely to offend her if you approach it like you're on the same team and trust that she has your son's best interests at heart.  If she won't agree to that, then I think you have every right to politely ask that she skip the under-the-diaper checks and instead reassure her that you'll let her know if there's ever a problem in that area.

[Super~Single~Mama]

Originally Posted by AnnDMFT 

Any words of advice for how you handled a judgmental and uneducated doctor? 

My ped tried to retract ds at his 12mo visit I believe.  I stopped her, told her she was not allowed b/c the foreskin is attached to the glans......he wasn't able to retract yet....blah blah blah.

She then told me it wasn't true, and I said that Yes, it is true, you need to do your research, b/c I did mine.

She hasn't given me any problems since then, and has been wonderful during unrelated problems (febrile seizures resulting in a short hospital stay as an example).  She also has not tried to retract again.

[Super~Single~Mama]

Originally Posted by Pirogi 

If you feel like trying to educate her, there are many threads here about ways to inform a doctor of harmful or outdated practices and beliefs.  I believe there is even a lawyer who will help you send a letter to the practitioner outlining the legal implications of improper care.  But, this may set you up for an adversarial relationship.

Hope others will chime in here.

Ok, I have another idea and can't multi-quote.
 

Having a lawyer send a letter may set the stage for an adversarial relationship, but a letter from a foreskin friendly Dr. might be a better idea?  That way its from someone on her same level, from a peer, and won't be made in a threatening way (does that make sense?).

Since you already have an established relationship with her, due to your dd's care, she may have respect for you already since she knows how you deal with your dd's immune problems.  I would approach her with the information that you have from reputable sources (this forum can help with that!), and tell her that you really like her as a ped, but you need to know that she has up to date information on this issue.  I don't know if she is a mother, but she may have a circ'd son - which could put her on the defensive, so just approach as respectfully as possible.

[MCatLvrMom2A&X]

Even though it is standard care for the Dr. to do the under diaper check. You do not have to allow it. I stopped allowing and touching other than the testicles when ds was and infant after having to physically remove the peds hands from him. You are the one in charge not the Dr. so if you dont want something done it shouldnt be done.

From now on I would just say something simple like "I know you need to check the testicles for hernia but please do not touch his penis in any way" I have said that same phrase several times now and while I get a bit of a look they respect my wishes. It sure beats having to deal with a baby in pain or with an infection because a Dr. just had to look under the foreskin.

[eepster]

Considering your complex situation, I would go to a no taking off the diaper policy.  The only thing down there that should need checking is that his testicles are fully descended and stay that way.  This something you can learn how to check for yourself.  I would also make the subject off limits for talking about in front of him, since as his language skills improve her comments might start to effect his self-esteem.

I would explain to her clearly why you are making this decision, so that she has the opportunity to choose to learn more about proper care for the intact penis if she cares enough.  Knowing that there is a problem is the first step to solving it.

[MsFortune]

I would not make it into a big deal.  Just next time she goes near his penis or diaper, say "please don't retract the foreskin".  And just leave it at that.

If you state your wishes clearly typically people will respect them, even if they don't agree with them.

[MCatLvrMom2A&X]

The only problem with saying "dont retract" is that many Dr's do not see moving the foreskin around as retracting when it most definitely is. So you need to use wording they cannot misunderstand. Either "do not move his foreskin" or the one I use "do not touch his penis/foreskin"

It was really hard for me to tell the ped. not to retract ds and I actually waited to long to say anything. The diaper was off and the Dr. had ds's penis in had and I saw what he was about to do and said "stop dont do that" and by that point he had already retracted ds a little at which point I removed his hand and said again for him not to do it. The next ped I told ahead of time "dont retract him" he said he wouldnt then proceeded to push ds's foreskin back

That was when I put into effect the no touching of the penis rule. Just easier that way and no worries about ds getting hurt. I keep the ped's because of the office hours and because they have seen dd since birth and with her health issues I prefer staying with them. It dosnt have to be an all or nothing thing though I would dearly love it if any of the Dr. there where foreskin knowledgeable but none of them are Even had the oldest ped to tell me ds's foreskin was to long and he might need circ for it I told him that it most assuredly was not to long as I had seen that first hand changing his diaper and he let it go.

[AnnDMFT]

I love all of those responses!  I love this forum already!   

[AnnDMFT]

Thank you for all of your replies!  I love that I'm not the only one dealing with these issues but find it totally sad that Dr's are so freaking stupid (yes, I went that far to use that word) that any little boy might be harmed by knowledge that could be acquired in reading about the foreskin's development. 

The advice my mom gave me (she was a peds nurse for 30+ years) was to bring it up before the doctor even starts the exam, something like:  "The first thing I want to talk about isn't why we are here.  My son is Intact and my husband I have done our research on foreskin and its normal development and we do not want anyone forcibly retracting his foreskin."

But, now I may end with: "....and because of some of the reactions by other physicians, I just ask that nobody touches his genitals at all." 

WDYT? 

[PlainandTall]

There is a letter regarding forced retraction at the Doctors opposing circumcision website. Although the letter may be phrased as if the retraction has happened, it's possible that mentioning the website/group would spark your doctor's interest in learning more. That site may present ideas that can hit home with her as a physician. I imagine saying something like- "i was reading on the DOC website that forced retraction of young boys is still a problem in the usa, and i'd like the reassurance that we are on the same page with this."

[jeminijad]

Originally Posted by PlainandTall 

There is a letter regarding forced retraction at the Doctors opposing circumcision website. Although the letter may be phrased as if the retraction has happened, it's possible that mentioning the website/group would spark your doctor's interest in learning more. That site may present ideas that can hit home with her as a physician. I imagine saying something like- "i was reading on the DOC website that forced retraction of young boys is still a problem in the usa, and i'd like the reassurance that we are on the same page with this."

I like this. I will go to great lengths to not offend an MD, or any mandated reporter. The thing I'm really afraid of is whether they retract them during the first exam after birth, which is the only one I may not be there for.

[Fyrestorm]

I would go for the no diaper off policy.  There is no reason he needs to be down there.  You can also print this off "INTACT CARE AGREEMENT"  Have her read it in front of you, sign it and put it in your son's file.

[Evergreen]

I might try to find a new doctor for my son and continue to take my daughter to that one.