"MD says too much in 8 yo dd's physical" - Page 3

[Nankay]

Great post, Jennifer!

(I'm a mom of an 11 yr old Aspergers kiddo)

[Viewfinder]

Okay, I understand the "developmental questioning," though, "Do you take your own showers?" falls under intimate, personal information that I have taught my daughter is private. So, the doctor asking that particular question, for the opening after I shut her down on blabbing all of my family medical history, was a bad choice. I think that one was out of line.

You know what it does? It makes a child think about being naked in a shower, and why is the doctor "putting" my thoughts there? Are they going to ask if I really used soap, or just tell Mom I do? Are they going to ask if I touch myself?" You know, eight-year old children are not babies anymore. They're exploring and discovering and more.

It would be nice if I could say, "oh, no biggee, it wasn't exactly a "scarring" experience," but guess what? My daughter has been regurgitating several topics that were taken up by the doctor that day. She's wanted to order "diet" soda at a restaurant, asked "am I going to get that disease?": pronounced, "The doctor said I'm supposed to eat meat;" and yesterday, "Mom, I am not going to eat ANY sugar for a week, because it's not healthy."

And this: last night, she said she is going to help me around the house a lot more, she is going to clean the bathroom every week.

And later, she got herself ready for bed with no reminder to tidy up her clothes, or brush teeth or the rest, and as I tucked her in, she recounted all that she had done.

What's wrong with any of those wonderful things, you might ask. Nothing, except that I am concerned what fire in her is feeding them all at once: what fear or doubt did that doctor visit implant in her that suddenly makes her want to HELP WITH HOUSEWORK so much (because she is now scared or worried about my health?), stop eating sugar, order diet soda... could it be that the information the doctor dispensed to my youngster scared her deep down?

It's all a learning experience for us now, for which I am not grateful. I have to explain to my daughter how doctors don't know everything, that they may get overfocused on things, and this conversation gets very complicated and I'm forced to put out a criticism to my child of a professional that I would prefer not to do. And I'm trying to explain the complexities of a medical education and that some doctors end up forgetting to consider people's beliefs and the power of words and, well, dd has left the room several minutes ago now. I can't explain it all away! It's like a virus that has infected our house and I will be treating it for a long time, like forever. My daughter now gets to go through the rest of gradeschool knowing that our family has cancer somewhere and an inherited emphysema--I was surprised to find that there is an emphysema that one can get not from smoking. My dad, a non smoker his whole life, was diagnosed at around age 70. Anyway.

I forgot today is a half day and schools out and thank goodness I'm just blocks away.

VF

[Brigianna]

Originally Posted by Jennifer Z

First, the vax question and family medical history were inappropriate, I agree, but I disagree about the 'weird questions'.

Here's why: Besides looking for red flags for abuse, a very real part of why they are asking the questions is to see how the child uses language, answers questions, and uses non-verbal communication (like the look she gave, thinking the questions were a bit over the top, told the doctor that she understood social appropriateness and had awareness that it wasn't something she normally talked about, ect). Questions about bathing and dressing riding bicycles, apart from probing into the lifestyle, also show whether or not motor planning is at an appropriate level.

Kids with some of the ASDs that don't involve language delays (especially Aspergers) are going to struggle with the way they use language (but the fact they do use language 'on time' kept it from being as obvious when they were younger, nor are they going to respond non-verbally as appropriatly. A lot of the ASDs have motor planning issues, so things like being able to get shampoo out of your hair and riding a bike, which are things most kids can do at that age, are going to put up some developmental flags too.

In order to evaluate how a child interacts, they have to interact and talking about what they can/can't do kills two birds with one stone.

dd nak now, i will retun

That's exactly why I think those questions are inappropriate. It's not a pediatrician's job to diagnose ASCs or developmental differences.

[PrennaMama]

Originally Posted by EnviroBecca

I think you should write a letter to the dr. explaining that this visit upset you and your daughter, for these reasons, and that you are considering changing doctors to avoid this type of thing in future. Include phone numbers where dr. can contact you to discuss the issue. If she's a good dr. who just had a blundering day, she'll call you and apologize and discuss how to do better and put a note in your file to remind herself. If she doesn't respond, don't go back. I have had very good success with this approach.

About the diet soda, my friend who is a family practice physician is very frustrated over many doctors' attitudes on this issue. Diet soda is NOT good for you! It's just bad in some different ways than sugary soda. A more appropriate response to finding out that a patient drinks soda is to indicate that it should be an occasional treat and to suggest healthy beverages. For a child who is not overweight, the wise alternative would be 100% fruit juice. What's wrong with doctors?! My friend thinks it's a lack of creativity and critical thinking.

:

Originally Posted by ThreeBeans

Yeah, what's with the diet soda thing? That's durned peculiar. I just can't imagine why a ped would suggest ANY kind of soda to a kid. Why not say, "Drink flavored waters instead of soda" or something along those lines?

The soda thing in our culture is seriously nuts. I can't drink diet. I'm alergic to aspartame. How about recommending, um... water??

Originally Posted by AutumnMelody

I haven't read this entire thread (a lot of it though). I think it brings up a lot of questions about the role of a family doctor.

At some point in our culture doctors got labeled as "absolute expert on everything". What exactly about medical school makes qualifies you as a child rearing expert, I'm not sure, but hey, they are the experts and I'm sure they know why.

I'm to the point where I will go to the doctor on my own terms for the diagnostics that I deem appropriate or for things like broken arms that need to be set and not much else. I really don't need someone to tell me (as an intelligent grown woman) that my baby shouldn't play with electrical cords and small objects. I don't need someone else imposing their moral and philosophical views on us. Nor do I need someone I don't know to teach my young children sex ed, or stranger danger, or the junk to eat that passes for nutrition these days. If I needed that I could send my kids to school and get it for free!

Now take all of that, and imagine it was coming, for free... from your FATHER IN LAW every time you saw him. Dh's dad is a ped, with his own practice, and dd goes to one of his docs cuz it's free, and they're pretty outsatnding... that not withstanding... he's a Harvard grad, New York-raised, Jewish Pediatritian. I was terrified we would have a boy and I'd have to go rounds with Dr.Dad about circ'ing. (Dh hemmoraged and nearly died after his, and even after that, he is still dead set in his conditioning that any son of ours will be circ'd... seriously praying for no sons...)

I feel you on the role docs play now... But I pose this: What if some of the questioning and 'probing' is being done in the spirit of a western medical attempt at preventative medicine? What if some of it comes from a place of sincere concern for children as a population? Or possibly from a desire on the doc's part to get to know and become familiar (keeping in mind the root of the word familiar) with the family as a whole, and cultivate a trusting and knowledgeable relationship with the kids and their families?

We're so ready for a fight these days, geared up to protect our little ones from the world... do we think maybe some docs could be trying to get back to the old school ways of the Family Doctor? You know, the doc that had dinner at your house once a month, knew everyone in town and their entire family histories, and was a respected and loved member of the community?

Viewfinder, it is deplorable that ANYone would discuss sex on any level with your child. And opening the can of worms without consulting u first was no bueno, to be sure. I hope you'll find a practitioner who is more to your liking, and fits your style better...

Statisitics when I was teaching 6th graders ten years ago, pointed to a trend that had developed, citing that children of the ages 8-12 had the cultural awareness, and sexual understanding 16-20 yos had ten years before, and that the curve was rapidly becoming steeper. The projection, 10 yrs ago, was that in 10 yrs time, 6-10 yos would have that same sexual/cultural savvy.

It is unfortunate and inconvenient to parents now, that we are in this postion of trying to provide reference and clarification of the terminology and scenarios they're hearing about... from peers, parents or siblings or friends of peers, etc... but having to worry about the family doc as a source of the TMI situation is really a bummer.... ...and should NOT be a concern. C'mon, docs, remember we're dealing with people's CHILDREN... and their innocense is SACRED.

[talk de jour]

Originally Posted by Brigianna

That's exactly why I think those questions are inappropriate. It's not a pediatrician's job to diagnose ASCs or developmental differences.

Oh, so the kid is just supposed to go on being undiagnosed until.... what??

If no one says anything, because it's not their job, where the hell does that leave the kid?

[PrennaMama]

Originally Posted by Brigianna

That's exactly why I think those questions are inappropriate. It's not a pediatrician's job to diagnose ASCs or developmental differences.

To the mamas who share this sentiment: What (in your view) is a pediatrician's job?

Do you think that early awareness of developmental anomoles, or abuse (either familial or maybe from peers), may come form regular visits to a trusted physician?

Should the observation of development and behavior, ability and 'cultural savvy' come from a pediatrician? Is it ok of it does? Why or why not?

I ask, because dh's dad (pediatrician and self-made expert on developmental imbalances like asbergers and ADHD) has at times really turned me off, and I was sincerely mad at the dude for about a year because of some of his opinions. I've made peace, and found a new respect for him as I am on my joureney to becoming a pediatric & family counselor. But I wonder about others who have this feeling, that a pediatrician maybe isn't the most appropriate candidate for these assessments... My take was that Pediatric MD does not a child-psychology/developmental expert, make.

[limabean]

Originally Posted by PrennaMama

But I wonder about others who have this feeling, that a pediatrician maybe isn't the most appropriate candidate for these assessments... My take was that Pediatric MD does not a child-psychology/developmental expert, make.

But they're the ones who have regular, ongoing contact with your child and a written history of their health and other factors. The MD typically doesn't treat the child for psychological problems, or even diagnose them, but rather catches something that may or may not mean something and refers the family to a specialist for further assessment and possible treatment. Who should be the one to try to catch this stuff if not the pediatrician?

FWIW, I support physicians who have a whole-patient approach to healthcare, rather than just treating the specific symptoms the patient presents with at their visit, so I may be biased about this issue.

[Jennifer Z]

Originally Posted by Brigianna

That's exactly why I think those questions are inappropriate. It's not a pediatrician's job to diagnose ASCs or developmental differences.

In order to get into a developmental peditrician, you usually have to be recommended by a regular MD or ped. because they are extremely high demand and very few of them out there. (only one for most of the state of Kansas, and one more in the Children's Hospital in KC that serves that area) Appointments for people who are qualified to make a diagnosis are often six months to over a year out (our first appointment was 14 months out when the Peds office called, and 18 months out for the next appointment if we couldn't make the first one)...you can't just call and get an appointment next week. If you can get a follow up appointment with a Dev. Ped., you are doing great if you can get it in 3 months.

A regular Ped or MD can order all the testing to eliminate genetic or other biological causes so that first appointment with the Dev. Ped. can actually be worthwhile instead of just arranging for the battery of tests at that point and waiting another 3-6 months for an actual evaluation and diagnosis.

A lot of behavioral, developmental, and psychological issues have a biological basis, so it makes sense to go to somebody with the authority to order those tests so you have more idea what you are, or are not dealing with. Plus, a lot of insurance companies require you go through a regular doctor first or they won't pay for the specialists. Some specialist's offices won't take an appointment from a lay person because they are too busy and there is too much need for them to possibly waste their time on somebody who's problem could be solved by somebody less specialized, thereby putting a kid who really needs them farther back in line.

And, the question about showering...I still would say it was totally appropriate. If a parent still has to help the person remember to wash everyplace or help make sure they are rinsed at an age when most kids do it independently, a dr. is not going to assume the kid is going to be washed by a perv, but that there is a genuine issue, be it motor planning, or remembering the 'list' of things you need to complete to be clean. Unless that doctor asked if she masturbates in the shower, I fail to see why it is inappropriate to ask the question.

Doctors HAVE to ask "personal" questions to assertain possible issues. "Does it hurt when you pee?" can mean the difference between catching a bladder/kidney infection before it becomes systemic. "Does it hurt when you have sex?" can mean catching Endo in time to save your reproductive life, "How often do you poop" can catch bowel problems. They are working with real people, with real bodies, that give symptoms that indicate when those bodies aren't working right. There is no difference to a doctor between an ear and a vagina in terms of how 'intimate' something is, except that a doctor with a good bedside manner will understand that most people have a different societal norm than they do at their workplace.

[PrennaMama]

JenniferZ and limabean: Well said!

Anyone else have a take? On what a ped's job actually is or should be?

[JustJamie]

I bring up every issue I can think of with my DD's ped, because it's entirely possibly that the ped really DOES know more than I do about the human body and the development of a child.

[Viewfinder]

My personal parameters for MDs with my DD

Lots of good discussion.

I found it settling to have this interchange of opinions and information. I hope that readers and participants are getting better prepared to deal with doctors who say too much, who have lost sight of the power of their words, and who may be bending too much to the sway of pharmaceutical company's money-making machinery.

I personally hold practitioners of medicine in pretty high esteem. I believe in modern medicine: I use many pharmaceuticals with doctor's prescriptions and I can thank them for my life and health a few times over. I think naturopathic, homeopathic, chiropractic and talk therapies, and spiritual beliefs could avert a huge percentage of discomforts and diseases BEFORE they need a medical intervention, and that is my opinion.

But, doctors are people: fallible people. They have their own opinions that affect how they dispense medicine and pepper it with their own twist on parenting, and sometimes, that's going to step on actual parent's toes. The MD I started this thread about certainly did. I appreciate her whole approach to giving my daughter a physical, but I don't appreciate how thoroughly, and in my strong opinion, inappropriately, she, the MD, included my daughter's young mind and heart into HER particular twist.

On the subjects of the probing questions, and the showering question, the ones that have garnered defenders of doctors' doing this, I "get it" in a little different way than I experienced them in that moment, and right afterward when my feelings had "landed" more "in" myself. I am sure that if this MD had approached the developmental questions less abruptly and not right after she began enumerating our family diseases and put me in an alerted "protective mode," I would not have batted an eye, and more importantly, my dd would have been less affected by the visit.

It is a fact of the nature of INFLUENCE, that if you get your subject into a state of confusion with conflicting facts, fear, or trauma, or certain types of emotional excitement, your words and actions are much more powerful... that is what happened here. The doctor confused and frightened my dd ("Mommy, what does great grandma's or your diseases have to do with me?), and me--which probably scared dd a little bit more, but I had to make the MD shut up before the list of family diseases got longer and more detailed. Then she added direct confusion to the mix with the wierd switcheroo to showering, and our home life, and then she launched into the gardasil pitch, the diet soda pitch, and some other stuff I'm not putting out here because I don't want it cherry-picked and defended until my main message is lost (though I do appreciate the dissection of the points in my criticism of the MD).

The point is, my dd was deeply affected, in a way I can not uphold as healthy for an eight year-old girl. It's okay and will probably be appreciated by MDs in the long run, for parents to tell them, more gently than I'm saying right now:

"In case you tend to be a blabbermouth and don't understand that I'm bringing my child here for a medical exam, not for implantation of fears, I'd like to give you some parameters of what is okay and what is not."

My personal parameters: Examine, test and question my child as per your medical degree, including developmental and abuse-detecting questions with a modicum of sensitivity to a child's personal modesty; and discuss any and all medical file information, diagnoses and treatment options with me alone, unless specifically okayed by me first.

VF

[Periwinkle]

That is so wrong!!

[Evan&Anna's_Mom]

Originally Posted by Viewfinder

The point is, my dd was deeply affected, in a way I can not uphold as healthy for an eight year-old girl. It's okay and will probably be appreciated by MDs in the long run, for parents to tell them, more gently than I'm saying right now:

And I certainly hope that you give the Dr. in question the feedback that you have given us. I think you are right -- this particular Dr. overstepped in lots of ways and it caused issues with you and your child. The Dr. needs to know this so she/he can do better next time. I doubt the Dr. meant to cause confusion or was deliberately trying to cause the reaction that occured. So you need to provide the feedback about your reaction and, perhaps more importantly, your child's reaction to the exam.

[PrennaMama]

Totally understandable... VF, you can call the practice or the hospital that is associated with this practice and get a Patient Satisfaction Survey, if you want to be annonymous, otherwise, do you plan to write a letter, or have a talk with the doc?

[Storm Bride]

Can I ask an almost totally unrelated question?

Do you all see pediatricians? Is this the norm in the US or something? I've never seen a ped (except the one who was there to examine my baby in OR), and don't know anybody who has.

[Nankay]

A specific example you stated re; taking a shower. My ped asked my 11 yr old a question like that in a way of subtlely reinforcing what we at home had been harping on. "YES! You HAVE to take a shower tonight!" It was leading down the road of "You're getting older now and..." she sorta talked about uping the hygiene level etc. etc. Sometimes an outside voice of authority holds a little more punch. The soda thing I don't get, and briging up the Gaurdasil vax like that was wrong.

Also, asking seemingly off the cuff questions are a way of measuring development/maturity. MANY parents can't see a delay because it's right before them everyday. They don't know what "normal" is so to speak. I ran in to this when I taught preschool. We had a kid who talked LOUD LOUD LOUD and nearly incoherently at age 3. We pointed this out to the mom and she had no idea what we were talking about. She had his hearing tested and lo and behold he was hearing impaired!.

[Jennifer Z]

I think I need to soften my response a bit to let the OP know that I have also experienced an aweful doctor that did more harm than good by the way he approached my son and us as parents, so I know the frustration and anger of a bad doctor very well. I fired that doctor and found a new one, and I suspect that is probably what you should do too since the doctor sounded like he is not a good match with you.

In our case, the doctor first berated us for delaying vaxes, then said he would "allow" us to not circ my (yet unborn) child if it was a boy, but highly recommended against it (it was a girl, and a new doctor by birth), and that it was 'way past time' for me to wean him, and he should be drinking cow's milk instead of breastfeeding, and numerous other insanities. He also kept throwing in things like 'since you are on medicaid...' and making subtle and not-so-sublte threats that he might report us to SRS for co-sleeping and non-compliance with vaxes, ect. By the time he got to the developmental questions, which, unbeknownst to us at the that time, were critical, I was wary of being totally forthcoming for fear of CPS and his previous comments. He also said that if he wasn't talking and wasn't evaluated by his next year's check up, he would make sure children's services was involved.

I was so shaken up and angry after the appointment, and because I was so disregarded and criticized in the earlier comments, by the time he got to the developmental stuff, I had pretty much shut down and wasn't giving anything he said any credence at all. A part of me is still very angry at him for being such a complete jerk because I know that if I had been approached differently I would have been much more willing to get Zane evaluated sooner, and we would have been in therapy much sooner. There will always be that 'what if' in my mind. The responsibility rests on my shoulders, and I should have taken some of the things he said to heart, but he and his horrible attitude certainly didn't help me make the best decision when I should have. Instead of including me as an intergral partner in caring for my son, he put me in an adversarial role of defending him.

My post wasn't really about individual doctors, but doctors as a whole in answer to why you would even go to a Ped/MD for developmental, behavioral, or psychological issues.

[Jennifer Z]

Originally Posted by Storm Bride

Can I ask an almost totally unrelated question?

Do you all see pediatricians? Is this the norm in the US or something? I've never seen a ped (except the one who was there to examine my baby in OR), and don't know anybody who has.

You used to just take your kids to a family doctor, and that is what I did growing up. In small towns, you are more likely to run into a family doctor, but for the most part they are becoming a rarity as they become replaced by specailists, including Peds. That is one reason so many OB/GYNs now do a lot more general practice things that they didn't do 20 years ago, because they are often the only doctor a woman sees, instead of having a general MD.

This is just a casual observance, and it might not be acurate for other regions, but it seems to be shifting that direction around here.

[Viewfinder]

In answer...

Nobody has to soft-pedal anything to me, Jennifer, but thank you, and I don't believe that the doctor planned to mess with anybody's head, E & A's Mom. I think she just blew it, but as she did so at my daughter's cost, it's important that I avert any future such blunders by being proactive.

My knowledge of how to influence people when you INTEND to informs my analysis of how she did when she didn't intend to.

I have an appt with her for myself in two weeks, and in the meantime, I'm going to write her a little note (polite and considered) to tell her what I truly think she will appreciate knowing, and will also talk to her face to face about it. I hope to improve our relationship, not end it. I think my input will help to make her a better, more successful doctor. And if she is non-receptive, I will request a switch to one of the other doctors there.

VF

[Storm Bride]

Originally Posted by Jennifer Z

You used to just take your kids to a family doctor, and that is what I did growing up. In small towns, you are more likely to run into a family doctor, but for the most part they are becoming a rarity as they become replaced by specailists, including Peds. That is one reason so many OB/GYNs now do a lot more general practice things that they didn't do 20 years ago, because they are often the only doctor a woman sees, instead of having a general MD.

This is just a casual observance, and it might not be acurate for other regions, but it seems to be shifting that direction around here.

Ah, okay. I'd been wondering for a while, as I see so many posts about "today's appointment with the ped" and such. Around here, most people are still seeing family doctors...or just going to clinics to see a GP.