Letter to my pediatrician - Page 2

[Pirogi]

So I got fired.  Here's the letter:

August 3, 2011

RE: Pirogi's son and Pirogi's daughter

Dear Pirogi

I find it necessary to inform you that I will no longer be able to provide medical care to your children.  After careful consideration I feel it best if you find another physician to go along with your philosophy.  If you desire, I will be available for emergency care and already scheduled appointments for 30 days.

This should give ample time to select a physician of your choice from the many competent practitioners in this area.  With your written authorization, we will make a copy of your medical records available to your new physician.

Very truly yours,

D. W., M.D.

[MCatLvrMom2A&X]

Well at least you know she/he wasnt willing to learn, which is beyond sad because no doubt other little boys will be hurt because of that unwillingness.

[HopefulJo]

Originally Posted by Pirogi 

So the good news is that she is the type of doctor that is fine with a parent asserting their right to refuse any part of an exam. The bad news is that I doubt it will affect any real change for other intact boys in the practice. 

It was a little disheartening, but I guess I did everything I could have done. Maybe she will read everything I sent over. She did say that she would photocopy the materials and provide them to the other doctors.

Looks like she wasn't the type to let a parent make these decisions (unless you think the other doctors in the practice made the call to fire you?) Good luck finding another practice that will respect you & your children! 

[Pirogi]

Yeah that's the weird thing.  When I met with her (referenced in the above quote), she actually said that it was fine with her for a parent to decline anything they weren't comfortable with.  Apparently she changed her mind?  The way the letter is written, it's a bit vague as to whether I am fired from the practice or just from her.  Is it common for a practice to blacklist someone and require that no one in the practice see them?

[APToddlerMama]

That is seriously outrageous.  Personally I would want to know what research she could provide you with to back up the assumption that she should be retracting little boys.  Also, there are some websites that allow you to rate doctors.  You might want to consider that.  Job well done on doing what you could, OP.  The fact that she is unwilling to accept responsibility and learn from her mistakes is really awful but you did as much as anyone can. 

[Agatha_Ann]

 

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Edited by Agatha_Ann - 8/13/11 at 9:19pm

[jenP]

Here's what would be awesome to be able to do: Interview every pediatrician in the area until you find one who actually understands that "retraction" means ANY manipulation of the foreskin back toward the shaft. Then, write your ex-doctor a letter explaining that, happily, you have found a physician whose training and education and cooperative, evidence-based approach suit yours and your children's needs to a "T." Explain that, although you are happy with your new doctor, you still worry about the potential for harm to other intact males in her practice, due to her mistaken notion that it somehow isn't "retraction" if it is only a "little bit." Therefore, you are asking the DOC to send her their standard letter in order to emphasize the seriousness of manipulating non-retractile boys' foreskins (and it IS serious; even though the likelihood of harm from the tiny amount of manipulation she does during a visit a couple times a year may indeed be very low, for parents to see her pulling back and messing with the foreskin could very well give them the idea they can and/or should do the same, whether to "check on things" or to clean), in the hopes that she will discuss this further with some of the outstanding, helpful, and knowledgeable physicians in that group.

I hope you really CAN find a doctor who understands that no retraction means NO RETRACTION! All the best to you.

You can take being dismissed from her practice as a badge of honor!

[PuppyFluffer]

Does this doctor have hospital privileges?  If so, I would contact the hospital (pediatric unit, risk management, patient advocate office) and inform them of your experience - the way you addressed it (the info you printed and the content of the talk in person) and the discharge letter you got. 

I would also contact Doctors Opposing Circumcision and have them send their usual stuff.

Thank you so much for following up!

[Pirogi]

Yes, she has privileges.  I had already contacted DOC but was going to try to meet with the doctor and discuss the situation with her face-to-face first, because I didn't want to get fired from the practice.  LOL!  I will contact the hospitals' Executive Officer, Risk Manager, Pediatric Department Clinical Director, and Patient Relations Coordinator.  I will also contact DOC again and ask them to move forward with the information they send.

[Pirogi]

Here's the letter:

" 

Dear Mr. M:

I am writing to inform you of an incident that occurred regarding one of the pediatric physicians who has privileges at ABC Hospital. The doctor is W, and she is in practice at ABC Pediatrics.

The incident in question occurred du...ring a regular 6-month well-child exam on 18 July 2011. My son is intact, and during the check of his genital area, Dr. W attempted to manipulate his foreskin backwards along the shaft while asking, “Are there any adhesions?” This was despite my holding my son’s penis with my fingers and repeating, “No retraction!” three times or more. Dr. W and I had already discussed the fact that my son’s urine stream flows straight and freely prior to the genital exam. It was distressing to me to realize that if I had not been so attentive, my son could have suffered unintentional pain and harm from his doctor. However, the interaction I have had with her since then is most concerning to me as a parent.

On 21 July 2011 I visited XYZ Pediatrics with the intent to drop off a letter with information as to the correct care of the intact penis, as well as current practice recommendations of the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). The letter is attached herein. I was pleased that the office manager of the practice, Ms. E, offered to see me and discuss the information. Ms. E then offered to ask Dr. W to join us for the discussion. Dr. W listened to the information I presented her. However, she claimed that manipulating the foreskin backward along the shaft was not harmful and was in fact necessary to check for hypospadias. Despite the fact that the foreskin is adhered tightly to the glans penis via the balano-preputial membrane, Dr. W believes that she is able to retract only enough to visualize the urethral meatus, and that by doing so she is not harming children. Dr. W also ignored information I supplied her that forced retraction can damage the sphincter of the preputial orifice, increasing the risk of phimosis and paraphimosis later in life. Dr. W’s beliefs and practices are in direct contradiction to current care guidelines by the AAP and the AAFP. AAP recommends: “Foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin.” AAFP recommends: “Don't try to force the foreskin to retract, because this can damage the penis and cause problems.” Dr. W informed me she would read through the materials I left with her and provide them to the other doctors in the practice. I thanked Dr. W and Ms. E for their time and attention, and we parted ways amicably.

On 10 August 2011 I received a letter from XYZ Pediatrics dismissing me from the practice. The letter cited no reason other than this statement: “After careful consideration I feel it best if you find another physician to go along with your philosophy.” I feel that this dismissal is in direct retaliation for my efforts to provide her with correct care information for the intact penis. I am concerned that Dr. W continues to provide dangerous, contraindicated care to the intact boys of Small Town, USA.

I would be happy to discuss this with you further. I can be reached on my cell at ##. Thank you for looking into this situation.

Sincerely,

Pirogi

Encl: 1. Letter to Dr. W
2. “Care of the Uncircumcised Penis” from AAP; http://www.growingchildped​iatrics.com/pdf/Uncircumci​sedPenis.pdf
2. “Circumcision” from FamilyDoctor.org, AAFP; http://familydoctor.org/on​line/famdocen/home/men/rep​roductive/042.printerview.​html
3. “The Development of Retractile Foreskin in the Child and Adolescent” from Doctors Opposing Circumcision; http://www.doctorsopposing​circumcision.org/pdf/2008-​03retractileforeskinleafle​t.pdf
4. “Short Warnings About Forcible Foreskin Retraction” from Doctors Opposing Circumcision
5. “Only Clean What Is Seen” from Kindred, Aug 2008; http://www.kindredcommunit​y.com/articles/only-clean-​what-is-seen-reversing-the​-epidemic-of-forcible-fore​skin-retractions/p/1253

cc: C, Pediatric Department Clinical Director
E, Risk Manager
K, Patient Relations Coordinator"

[APToddlerMama]

Also a really good letter.  Thank you for taking the time to do this.  It is really important. 

[MCatLvrMom2A&X]

I am so glad you are taking the time to do this and that you are doing it in a professional and responsible manner. Please keep us updated.

[Adaline'sMama]

Im sure she fired you because after she apologized to you for what she was doing you sent her a patronizing letter to tell her what she likely already knows and then talked to her secretary about it, and offered to come in and tell other people how she was screwing up. All over a three second ordeal that she immediately apologized for. I cant believe you wrote a letter to the hospital AFTER all that. Did you think she wouldnt fire you after that letter? I wouldnt want to keep seeing someone multiple times a year that assumed I was an idiot and offered to come and tell/show people the "right" way to do my job.

Just sayin, its really all about a good fit between the doctor and patient. I dont think she fired you for your opinions, I think she fired you because she didnt want to have to deal with things like this happening over and over again over the next 10-15 years. Its not a good fit if your patient is already writing you letters when her kid is still a baby. Its all about the risks she is willing to take. Moms who are writing letters like this when the patient is just 6 months old might well sue you for something when the kid is 10.

Also, she didnt retract him, and clearly told you she wasnt going to, so I dont see how your statement ."...continues to provide dangerous, contraindicated care to the intact boys....." is valid. Have you known this doctor to retract other boys? Have you know anyone who has seen her who has had problems with their intact sons? You state that her beliefs go directly against the AAP and AAFP. Has she discussed her beliefs with you , or are you just going off the fact that you were fired. Because, really, I dont think you were fired because you have different beliefs. I think you were fired because your behavior was over the top.

[WildKingdom]

Wow.  If I was your doctor I'd seriously be looking into suing you for libel.  You wrote in that letter to the hospital that she is providing dangerous care and you have absolutely no evidence to back that up.  She did not retract your son and you have no knowledge that she has ever done so to any child.  If she has her privileges suspended for an investigation based on your baseless accusations, she also has to suspend her office practice (insurance companies require that physicians that they contract with have active privileges at a hospital in most cases).  

If I were you, I'd write two more letters.  One should be a letter of apology to your doctor regarding these allegations, and the other should be to all of the hospital personnel that you send the letter to, stating that the first letter was an over-reation on your part.

Otherwise, you should probably lawyer up.  I'm dead serious.  A six-month investigation from a hospital and loss of privileges- that's a pretty serious financial impact to your doctor and I'm sure she'll act on it.  

[mare54]

oh well.  At least you know what your doctor is really about!  You will feel much better having a doctor that respects you more and you will trust more.  Good Luck.

[PhoenixMommaToTwo]

Originally Posted by WildKingdom 

Wow.  If I was your doctor I'd seriously be looking into suing you for libel.  You wrote in that letter to the hospital that she is providing dangerous care and you have absolutely no evidence to back that up.  She did not retract your son and you have no knowledge that she has ever done so to any child.  If she has her privileges suspended for an investigation based on your baseless accusations, she also has to suspend her office practice (insurance companies require that physicians that they contract with have active privileges at a hospital in most cases).  

If I were you, I'd write two more letters.  One should be a letter of apology to your doctor regarding these allegations, and the other should be to all of the hospital personnel that you send the letter to, stating that the first letter was an over-reation on your part.

Otherwise, you should probably lawyer up.  I'm dead serious.  A six-month investigation from a hospital and loss of privileges- that's a pretty serious financial impact to your doctor and I'm sure she'll act on it.  

Yes to all of this. Spending hours on the internet researching and compiling sources in no way makes your knowledge more superior than hers. AND she didn't retract! Holy crap, such a fuss over something that's a non-issue.

[oaktreemama]

I showed this post to my stepdad who is an attorney and he thinks you suffer the very real possibility of being sued. You have no backup to any of your claims. You have attempted to trash her reputation for what you admit was completely unintentional and caused your son no harm.

He suggested getting an attorney of your own because he thinks you will need one.

And boy oh boy-I would have fired you too. Good luck finding anther ped-this kind of stuff gets around and no ped in his/her right miind will want to deal with you.

[ElliesMomma]

IME working with doctors, they only listen to other doctors.

[zinemama]

Originally Posted by oaktreemama 

You have attempted to trash her reputation for what you admit was completely unintentional and caused your son no harm.

This is the part of your whole story that stands out to me the most. You admitted that she didn't harm your son. Yet you wrote that letter to her anyway. You trashed the doctor to her own office manager. You - a non-healthcare professional - offered to come train her staff! Then you took your non-issue to the doctor's hospital, which may well result in an investigation. All over something you admit was unintentional and caused no harm. I cannot fathom why you would do such a thing.

[PeterJ]

I think that we're all reacting a little too strongly here. My best guess is that having read the letter and having had the additional consultation with you, the doctor may have consulted her attorney who advised severing the relationship in order to avoid the possibility of further disagreements over care, and possible legal action down the road.

I would proceed with caution from this point on.  You have every right to file a complaint, but you do not have the right to potentially ruin the reputation of a doctor, when you have no evidence other than a retraction that did not happen.  At this point it is very unlikely that you will succeed proving your assertion that she provides dangerous care because you have nothing to back it up.  It's a very serious allegation, and you should be aware of the consequences of making such a claim, which appears to be based on your assumption about her care of other patients.

You've made your point.  You don't see eye to eye with this doctor.  Move on and find a new Pediatrician.