Letter to my pediatrician - Page 3

[chiefmir]

WOW.  Your feelings were hurt because you got fired, so you've tried to ruin this doctors life.  To be fair, I'll assume that a non-medical individual (who doesn't have family or close friends in the field or related field) may not have had any idea how devestatingly awful your actions against this doctor (who you actually seem to like a bit) could be.  I'm horrified that you'd like to ruin her career (not to mention everything else that can go along with that) over this NON-incident. FWIW, my DH is a pediatrician... a truely amazing one who has worked with hundreds or even thousands of non-circumcised boys and is 100% in agreement that what the doctor was attempting to do (if indeed she was only looking for that small peek) was never going to cause any harm.  He has handled a LOT more little boy, medium boy, and big boy penises than all of us put together, I assure you, and would certainly be telling the truth about this.  The idea of someone destroying his reputation within the office and then to professional organizations is sickening.  The didn't fire you because you didn't want your son's foreskin retracted or because you spoke up about it in the office visit.  They fired you because you took an incident that was a 2 out of 10 (at most) on the scale of awful and reacted as if it were an 11.  They were all afraid that every interaction with you could go this way and realized that you were not going to be willing to treat them like human beings (you know, the kind who can actualy do nothing wrong but apologize for not getting the visit exactly right but then don't have their career ruined over it) and decided that they had to spare themselves the 18 years of trouble.

Please apologize.  Call it new mom's overprotectiveness... tell them that you got sucked into the fervor of this issue because it is near and dear to your heart but that you don't have any intention of ruining this doctors life. They won't want to see you again as a patient, but perhaps you won't be sued.  If someone had done this to my husband, we'd already have TWO lawyers... the practice's lawyer and a personal one, just in case there was a way to go after you twice.  Just saying.

[MCatLvrMom2A&X]

you attempted to manipulate his foreskin backwards towards 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.

She did attempt to multiple times after being told not to this is a major violation of the trust between the Dr. and the OP that alone right there is grounds for complaint.

[QueenOfTheMeadow]

Bmhpke96-
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[bmhpke96]

Post edited for respectful clarification.

[PuppyFluffer]

I disagree with those who think this mother is overstepping.  The AAP guidelines clearly state that no retraction should be done to an intact child.  This child's foreskin was not retracted only because the mother was informed and present to prevent the doctor from retracting.  The doctor certainly was not doing to cease her efforts to retract simply because the mother asked her not to do so.

I've been in this exact situation for the placement of a urine catch bag.  I clearly said "My son is intact, he is not circumcised.  Do not retract his foreskin."  Nurse said "ok, no problem".  She procedes to use the sterile wipe on his penis from base to tip, then lifts the penis with her index finger and thumb and begns to slide the foreskin back towards the body.  I stated "You are retracting, stop."  She didn't.  I removed her hand from my child, at which point she got totally indignant with me and another woman in the room said "What?  Don't you clean him?"  In my case, I talked with the head physician in the ER about a separate incident.  I said to her, while we are talking about this, can I discuss another concern I have?  She said yes and I proceeded to explain what happened, the harm of forced retraction and the fact that my request was agreed to then ignored.  She was extremely apologetic and said "You are absolutely correct, I have two intact sons myself.  I am very sorry this happened and I will look into it."  And honestly, I believe she actually did follow up and look into it.  She knew I was completely right in my knowledge that forced retraction is potentially harmful.  If a parent took a female child in for an exam and she left with torn bleeding genital tissue, I think most everyone would agree that it was assault upon the girls genitals.  We don't consider that boys need the same protection.  It's time we do and it's actions like following up on issues of inappropriate care at the hands of medical professionals that will make things change.

[Sarahfeena]

Originally Posted by PuppyFluffer 

I disagree with those who think this mother is overstepping.  The AAP guidelines clearly state that no retraction should be done to an intact child.  This child's foreskin was not retracted only because the mother was informed and present to prevent the doctor from retracting.  The doctor certainly was not doing to cease her efforts to retract simply because the mother asked her not to do so.

I've been in this exact situation for the placement of a urine catch bag.  I clearly said "My son is intact, he is not circumcised.  Do not retract his foreskin."  Nurse said "ok, no problem".  She procedes to use the sterile wipe on his penis from base to tip, then lifts the penis with her index finger and thumb and begns to slide the foreskin back towards the body.  I stated "You are retracting, stop."  She didn't.  I removed her hand from my child, at which point she got totally indignant with me and another woman in the room said "What?  Don't you clean him?"  In my case, I talked with the head physician in the ER about a separate incident.  I said to her, while we are talking about this, can I discuss another concern I have?  She said yes and I proceeded to explain what happened, the harm of forced retraction and the fact that my request was agreed to then ignored.  She was extremely apologetic and said "You are absolutely correct, I have two intact sons myself.  I am very sorry this happened and I will look into it."  And honestly, I believe she actually did follow up and look into it.  She knew I was completely right in my knowledge that forced retraction is potentially harmful.  If a parent took a female child in for an exam and she left with torn bleeding genital tissue, I think most everyone would agree that it was assault upon the girls genitals.  We don't consider that boys need the same protection.  It's time we do and it's actions like following up on issues of inappropriate care at the hands of medical professionals that will make things change.

That would all be relevant if, in fact, the doctor had retracted the baby's foreskin, which she did not. 
 

[Night_Nurse]

 How many times have we heard of a doctor retracting (or trying to in this case) a boy because they have never been taught any better? Numerous times that I can remember. I'm guessing this mama was scared and was only trying to educate the doctor in order to prevent any boys from being harmed. I don't think she should have written the hospital but she did and calling her names isn't going to change that. IDK, I guess the OP got her feelings a little hurt that she was fired from the practice and maybe that fueled the letter to the hospital. But I think at the core of it, when all of this got started, it was because she felt her repeated request to prevent any harm to her son was ignored and she was trying to be protective of any future boys/incidents. The doctor should have stopped trying to exam the penis the first time mama asked. She shouldn't have had to ask several times.

OP, I really don't think you will be sued or that the hospital or doctor will take any action. I could be wrong. I don't know where you live and every state is a little different. I've been a nurse for over 20 years and also worked in the hospital in records in a non-nursing capacity. In my state, writing a letter to a hospital would do absolutely no good unless 1 - the event took place in the hospital or 2 - the doctor is an employee of the hospital (like a pathologist or E.R. doctor). Pediatricians usually are independent (not employed by the hospital) and while they have hospital admitting privileges, they won't be revoked or even investigated over a patient letter concerning something that happened in the Drs private office. In my state, if you have a complaint against a doctor, you can contact the state medical licensing board. They are the ones who can investigate the complaint. In every doctor's office, they legally have to post how a client can make a complaint. It usually is posted in a frame on the wall w/ the medical board address & phone #.  Or, it might be on the bottom or back of your office receipt. However, some of the complaints they get are about surgical or medication errors, billing fraud, etc. Since your son suffered no physical harm, I doubt the board will do anything other than keep it on file. There's no way the doctor would lose their license to practice over this, and I certainly don't mean to imply that that is what you were wanting.

Again, I could be wrong and I'm certainly not giving any legal advice but I don't think the hospital will do a thing. I doubt they'll even tell the Dr. a letter was received. Feel free to contact your state medical board if you feel it's necessary but maybe you should just let it go and see if you can find another doctor who will respect your wishes to not touch your child's penis. If he's urinating fine, there really is no reason the doctor needs to look at the meatus (urethral opening).

I feel you came here to post about your situation for support and then the thread took a hostile turn. I hope you still feel comfortable here posting any questions or problems you may have with your son.

[Agatha_Ann]

eta-Sorry, wrong thread!

[lovingmommyhood]

Originally Posted by Pirogi 

In her defense, I really do think the pediatrician wasn't willfully trying to do something in defiance of my protests.  The whole "struggle" with his penis lasted probably two or three seconds total.  After which she said, "Oh!  We aren't even doing that, OK.  Sorry, it just doesn't always sink in right away."  She didn't continue with any reasons as to why she thought it was necessary, or that I should be doing it, etc.  She just went on with the exam.  

So, I don't think it was willful, but it still does indicate that this was part of her "autopilot" exam for intact boys.  Which is the whole point of trying to provide her with education.

And sorry, but I am kind of an expert on this.  I have correct, research-based, professional organization-endorsed information that I have spent hours compiling and checking sources, etc.  She is much more broad and general in her knowledge.  I am offering my knowledge to her.  I don't see that there is anything wrong with that.  I think the issue that some people are having is that this is a doctor, and doctors are revered in our society.  I think it feels to some like some kind of subversive maneuver for a non-medically trained person to educate a medically-trained person.  Why should that be so?

OP, I think the complaint to the hospital was a major over-reaction as you admitted yourself that the struggle was really a non struggle...and two or three seconds hardly seems enough time for her to make multiple attempts at retracting him. I'm also having trouble visualizing how this is happening if you're holding your son's penis. 

Edited by lovingmommyhood - 8/14/11 at 12:34pm

[PuppyFluffer]

Originally Posted by Sarahfeena 

That would all be relevant if, in fact, the doctor had retracted the baby's foreskin, which she did not. 
 

My son was not retracted ONLY because I was educated AND prevented it from happening physically.  The OP's son was not retracted because she did not physically allow it.  If neither of us was educated AND proactive, our sons would have been retracted, thus tearing their genital tissue and causing them harm and pain.  Her informative letters are not about whether her son was harmed but about the fact that her son would have been harmed had she not prevented it.  It stands to reason that both of the medical care individuals we both saw were accustomed to retracting on a normal basis.  The issue isn't about whether her son was harmed (he wasn't) but about bringing a health care professional's knowledge and practice up to speed on accurate information and procedure.  In the case of the OP, the doctor doesn't seem interested in changing her care.  The OP's actions are for the benefit of other boys that will be in her care.  The chances are that many of the peds retract and that most of the nursing staff may not know proper intact care.

In todays world, most people wouldn't bother taking any action if it didn't directly impact themselves personally.  The OP is acting for the benefit of others and I support that!

[QueenOfTheMeadow]

Originally Posted by QueenOfTheMeadow 

Bmhpke96-
Your post is unacceptable. We have opened up the user agreement to allow for open discusion, but we still expect members to be respectful. Disagreements are fine, but they need to be worded respectfully. Please edit your post or it will be removed.

Per the user agreement,

To support the open exchange of ideas and opinions, Mothering.com members are required to treat one other with respect and courtesy at all times.

Your post has been removed for being disrespectful. Adding respectfully before your post is not editing out the objectionable part of your post. Please refrain from posting in this manner again.

[Pirogi]

Wow.  I haven't checked in since Friday.  I will try to address the concerns voiced here individually.
 

Originally Posted by 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.

 

But she didn't already know.  That's the thing.  My intention was to drop the letter at the office for the doctor and office manager (who is different than a secretary) to read when each had time.  The office manager offered to speak with me and to ask the doctor to be part of the conversation.  I believe it is appropriate to cc an office manager when a patient has a concern with how a doctor is practicing.  I never assumed she was an idiot, only uneducated about proper care of the intact penis.  I was right about that.

Also, I really would be interested to know exactly which part of the letter to the doctor was patronizing.  What verbiage specifically comes across that way?

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.

While I recognize litigation fear that most medical providers have, this logic doesn't make sense to me.  So ... people are only valuable enough to receive proper care once they are out of infancy?  Dr. Seuss disagrees with you.

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.

She told me that a parent can always opt out of any part of an exam.  Which implies that other boys will indeed be subject to retraction during a well-child visit.  Yes, we discussed her beliefs during the visit with the office manager.  She does believe that retraction is a valid part of a well-child exam.  

[WildKingdom]

Originally Posted by Night_Nurse 

OP, I really don't think you will be sued or that the hospital or doctor will take any action. I could be wrong. I don't know where you live and every state is a little different. I've been a nurse for over 20 years and also worked in the hospital in records in a non-nursing capacity. In my state, writing a letter to a hospital would do absolutely no good unless 1 - the event took place in the hospital or 2 - the doctor is an employee of the hospital (like a pathologist or E.R. doctor). Pediatricians usually are independent (not employed by the hospital) and while they have hospital admitting privileges, they won't be revoked or even investigated over a patient letter concerning something that happened in the Drs private office. In my state, if you have a complaint against a doctor, you can contact the state medical licensing board. They are the ones who can investigate the complaint. In every doctor's office, they legally have to post how a client can make a complaint. It usually is posted in a frame on the wall w/ the medical board address & phone #.  Or, it might be on the bottom or back of your office receipt. However, some of the complaints they get are about surgical or medication errors, billing fraud, etc. Since your son suffered no physical harm, I doubt the board will do anything other than keep it on file. There's no way the doctor would lose their license to practice over this, and I certainly don't mean to imply that that is what you were wanting.

I believe you are wrong.  I am on my hospital's credentialing committee, and I can tell you that we take complaints about quality of care extremely seriously. All complaints are investigated.  It doesn't matter whether or not the doc is a hospital employee- if they have privileges then they practice within the hospital, and subject the hospital to liability.

If anything, the pediatrician is MORE like to have her privileges suspended, as she is not an income-generator for the hospital, since she does not do procedures there.  Any kids that get admitted can just be put on the service of another doctor.

[Pirogi]

Quote:

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).  

Your point is valid here.  I have actually not mailed the letters yet, since I wrote it on Friday.  I will change "I am concerned that Dr. W continues to provide dangerous, contraindicated care to the intact boys of Small Town, USA." to "I am concerned based on Dr W's responses during our meeting that she believes retraction is a valid part of a well-child exam.  If this is true, this belief puts the intact boys of Small Town, USA at risk."  Another thing I will change is to clarify that Dr. W did not wear sterile gloves during her attempted retraction of my son, based on information I received from DOC.

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.  

I won't be writing any letters of apology.  I did not over-react.

[Pirogi]

Originally Posted by ElliesMomma 

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

Doctors Opposing Circumcision believes this to be true also, which is why they do what they do.  I will be contacting them before I actually send the letters.  If they agree that there is no basis for them to send out info, I will also not mail my letters.

[Pirogi]

Originally Posted by zinemama 



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.

Why am I concerned?  Because I believe (but cannot prove) that she retracts other boys during well-child exams.  That's why I would do such a thing.  Because I care about the other intact boys in my community.  Because forced premature retraction can increase the risk of scarring, infection, adhesions, phimosis, paraphimosis, emotional distress, and circumcision later in life.  Aren't we all here for that reason?  To prevent unnecessary circumcision and to promote the health of intact children?  

I did not trash anyone, simply stated what happened and provided educational material.  And non-healthcare professionals offer in-service training all the time.  Doulas at hospitals come to mind.  And her actions were uninformed, not unintentional.

[Pirogi]

Originally Posted by 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.

Thanks, PeterJ, for your respectful post.  I agree with you for the most part.  I don't wish to malign anyone.  If there is anything further I can do to make sure that her conduct is in accordance with recommended care guidelines, I want to do that.  DOC should be able to advise me on that.  

[Pirogi]

First of all, writing "just saying" at the end of rudeness doesn't negate the negativity that came before.  I have no intention of ruining anyone's career.  And actually, you have no idea how I acted or reacted, as you weren't there.  All you have seen is the letters I have written.  I was very professional and respectful during all interactions.

I believe that your husband is a pediatrician, and I believe that he believes he provides excellent care.  I don't know how he practices, so I can't comment on that.  What I do know is that Doctors Opposing Circumcision, which is an organization made up of doctors and lawyers, disagree that retraction of any sort is harmless.  The only exception is when the doctors moves the foreskin back only to the point of attachment, and only if the doctor has washed their hands and is wearing sterile gloves.  This is from their FAQ: 

"*Note: some knowledgeable docs will gently and carefully retract the child’s foreskin to the boundary where the balano-preputial lamina attachment occurs. This is permissible in the (washed and gloved) hands of a professional who otherwise knows this anatomy, a rare person in our experience. Assuming that is all that occurred, this is no cause for a formal complaint unless the retraction is more aggressive and there is pain, bleeding, and swelling and/or you saw the child’s glans appear in whole or part. Even this exam technique is unnecessary –the need to see the urinary meatus in a healthy child is imaginary--but it is also not harmful enough to warrant a formal complaint."

I may well be that DOC doesn't believe there are grounds to take any further action, and if that is the case I will of course not send the letters.  I want to do everything I can within appropriate boundaries, but I will not act inappropriately.
 

Originally Posted by chiefmir 

WOW.  Your feelings were hurt because you got fired, so you've tried to ruin this doctors life.  To be fair, I'll assume that a non-medical individual (who doesn't have family or close friends in the field or related field) may not have had any idea how devestatingly awful your actions against this doctor (who you actually seem to like a bit) could be.  I'm horrified that you'd like to ruin her career (not to mention everything else that can go along with that) over this NON-incident. FWIW, my DH is a pediatrician... a truely amazing one who has worked with hundreds or even thousands of non-circumcised boys and is 100% in agreement that what the doctor was attempting to do (if indeed she was only looking for that small peek) was never going to cause any harm.  He has handled a LOT more little boy, medium boy, and big boy penises than all of us put together, I assure you, and would certainly be telling the truth about this.  The idea of someone destroying his reputation within the office and then to professional organizations is sickening.  The didn't fire you because you didn't want your son's foreskin retracted or because you spoke up about it in the office visit.  They fired you because you took an incident that was a 2 out of 10 (at most) on the scale of awful and reacted as if it were an 11.  They were all afraid that every interaction with you could go this way and realized that you were not going to be willing to treat them like human beings (you know, the kind who can actualy do nothing wrong but apologize for not getting the visit exactly right but then don't have their career ruined over it) and decided that they had to spare themselves the 18 years of trouble.

Please apologize.  Call it new mom's overprotectiveness... tell them that you got sucked into the fervor of this issue because it is near and dear to your heart but that you don't have any intention of ruining this doctors life. They won't want to see you again as a patient, but perhaps you won't be sued.  If someone had done this to my husband, we'd already have TWO lawyers... the practice's lawyer and a personal one, just in case there was a way to go after you twice.  Just saying.

[Pirogi]

Originally Posted by lovingmommyhood 

OP, I think the complaint to the hospital was a major over-reaction as you admitted yourself that the struggle was really a non struggle...and two or three seconds hardly seems enough times for her to try multiple times to retract him. I'm also having trouble visualizing how this is happening if you're holding your son's penis. 

I don't know what you mean, that I admitted the struggle was really a non-struggle?  There was definitely some physical maneuvering going on.  When the diaper came off, I immediately put my hand on my son's penis and held it upward toward his torso.  She felt for and pulled down on my sons's testicles, which caused him to cry, and I momentarily looked at his face and tried to comfort him.  Then she reached for his penis.  I believe that she thought I was holding it up just to keep it out of the way of the testicular exam, and she was physically taking it to perform the urinary meatus check.  She was intentionally trying to remove my hand from his penis/worm her fingers under my hand so that she could pull back the foreskin.  And she did pull it backwards a little, although because my son has ample foreskin, I did not see the glans.  He continued to cry pretty loudly until she took her hands off of him and I picked him up and held him against my chest.  He didn't calm completely down (whimpering) until she left the room.  It was one continuous attempt on her part, continually pulling the foreskin back while I held the penis.  I said, "No-retraction-no-retraction-no-retraction" quickly.  Does that clear it up?

[WildKingdom]

Just want to make sure that you are aware- DOC is not some sort of regulatory body.  They do not have guidelines that are accepted by any formal group, such as the AAP or the USPTF.

Also, I see nothing in the quote you posted about wearing sterile gloves.  It just says "washed and gloved" not "sterile gloves."  In general, the washing of the hands is for the patient's protection, but the gloving is for the doctor's protection.  Because touching anyone's genitalia who is not your own baby or partner without gloves...ewwww.