12 year old physical....... - Page 4

[aniT]

Originally Posted by lorijds

No, my point was to show the difficult position practitioners are put into, and how the pendulum of opinion would swing the other way in the case of an abused child who had "normal" physical exams. Then he/she would be hung out to dry by the public AND the court system. Puts them in a tight spot, eh. I was asking you to view the rationale from the practitioner's perspective. And every time a parent or child refuses that part of the exam, that's what's going on in his/her head. Is this kid/parent refusing because the child is shy, or are they refusing because there is some sort of abuse they are trying to hide?

At the age of 12, they should be asking the parents to step out, anyway, to ask questions about drugs, smoking, alcohol, and sexual activity, and to discuss the practice of patient confidentiality. And that's the point when they should also clarify WHY the child is refusing the exam.

Maybe shyness has nothing to do with it and they just don't want a stranger poking around in their private parts. A child doesn't have to be shy to want to keep their privates private.

As for stepping out.. Yea right.. If a doc told me to leave I would be taking my child with me. I will NEVER leave my child to be bullied by a so called doctor again. She once had a tooth pulled with NO PAIN meds. They just sedated her so she couldn't move and janked the thing. When I brought her home she told me I "lied to her" because I told her they would give her medicine so it wouldn't hurt. It was standard practice for parents to "step out" there too. Never again!

And what makes you think a child would tell the doctor the truth even if the parents weren't in the room? I didn't. I mean come one just because it is a doctor asking someone is going to admit to taking illegal drugs? It would be a pretty naive doctor to believe they would. Especially when they are just in there for a physical, not due to a problem.

[lorijds]

I think it's disrespectful of your child to not allow her privacy with her practitioner, either. When we do exams on kids 12 and older, we always ask the parent to step out for a few seconds while we ask some personal questions, and we tell them we will ask them right back in; and we do, unless the child requests otherwise.

We take a moment to explain to them the concept of patient confidentiality, and how they can always come to us with questions and concerns with or without the knowledge of their parents; that we ENCOURAGE them to always ask questions of their parents; but if they feel they can't, or if they need to discuss things with us first and then have us help them discuss a medical concern with their parents, they can contact us. We also ask about certain activities at that time. Very few children are going to admit to the use of alcohol, drugs, or nicotine, or sexual activity, in the presence of their parents. The third thing we discuss is whether they feel safe in their home and school environment. Finally, we ask them if they have anything they want to discuss with us during this visit. If they bring up any topics, we ask if they want to discuss these things before their parent returns to the room, or afterward.

These are things your child has the right to discuss in the absence of your presence. You are hindering their right to privacy with their practitioner, and therefore their access to health care, when you refuse to leave.

[aniT]

Originally Posted by lorijds

I think it's disrespectful of your child to not allow her privacy with her practitioner, either. When we do exams on kids 12 and older, we always ask the parent to step out for a few seconds while we ask some personal questions, and we tell them we will ask them right back in; and we do, unless the child requests otherwise.

We take a moment to explain to them the concept of patient confidentiality, and how they can always come to us with questions and concerns with or without the knowledge of their parents; that we ENCOURAGE them to always ask questions of their parents; but if they feel they can't, or if they need to discuss things with us first and then have us help them discuss a medical concern with their parents, they can contact us. We also ask about certain activities at that time. Very few children are going to admit to the use of alcohol, drugs, or nicotine, or sexual activity, in the presence of their parents. The third thing we discuss is whether they feel safe in their home and school environment. Finally, we ask them if they have anything they want to discuss with us during this visit. If they bring up any topics, we ask if they want to discuss these things before their parent returns to the room, or afterward.

These are things your child has the right to discuss in the absence of your presence. You are hindering their right to privacy with their practitioner, and therefore their access to health care, when you refuse to leave.

Wow, I just don't even know where to begin with this post. I am sure you believe what you are saying is true. I however do not agree with you. I have had too many doctors try to intimidate me, call me a lier, and flat out lie to me about "required procedures." I wouldn't put it past a doctor to try to strong arm my child into a vaccine that she does not need or other "necessary" medical procedures. (In this case a pelvic exam.)

99% of children WILL NOT admit to using alcohol, drugs, or having sex even without the presence of their parent. I would have lied to the doctor, as would all my friends. You are deluding yourself if you believe otherwise.

I also know my child and I know her well. She would NOT discuss ANYTHING with a stranger, she would be UPSET if I left the room and she was forced to talk to the doctor herself, and she would just sit there like a lump when/if you tried to talk to her when I was not present. Hell she got pissed off because a clerk at the Van's store talked to her while I was taking one of the younger kids to the bathroom. Yes, eventually she will grow out of this, but right now she is only 13 and at 13 I don't believe she is old enough to be thrown to the wolves in the medical profession to strong arm her into doing whatever they want.

Also I would like to point out, should my daughter need an exam of this nature and doesn't want to discuss it with me, I have shown her where the local pregnancy resource center is, "just in case her or one of her friends needs their help."

If my daughter seeks health care without me being there that is going to be up to her, not some doctor with a god complex.

[veganf]

Originally Posted by gumby74

Dh and I adopted my brother, who is now 12. Yesterday DH took my brother to get a physical for camp. As soon as the doctor told him he was going to have to look at his testicles.....my brother freaked and left the room and ran outside of the clinic. He refused to have the physical and did not care that he would no longer be able to go to camp. My brother is diagnosed with bipolar disorder, which I realize has something to do with the behavior and the reaction to the physical, but the reality is.......he is eventually going to have a testicular exam whether he likes it or not. Soooooo my question is: "How do I get him to go through with it?' To my knowledge he has never been sexually abused. I really feel this has more to do with his need to stay in control of every situation, as well as the fact that he is embarrased. Any thoughts and suggestions would be appreciated.

I'd have done the same thing at that age. I think it's unnecessary and embarassing. When he's older and can understand why it's important and has gotten over the pre-teen identity stuff, then sure. I'd talk to the doctor or take him to a different one, but come on, why does a doctor need to be feeling up a 12 yo. If there was some anatomical problem it would have most likely been identified as a baby or young child.

[CallMeMommy]

Originally Posted by lorijds

I'm sorry, how many times can I say, "If your child doesn't want the exam, fine" before someone actually reads that line?

I hate to use your post as an example, but it's been implied in previous posts but you actually come out and say it. Generally, I'm wondering what kid would ever WANT a pelvic/genital exam by a doctor? Why should it even be offered if there's not a pressing need? Obviously some kids and parents are going to think they HAVE to submit simply because the doctor offers it and some kids and parents will feel foolish declining even if the doctor gives them an out. Why even go there if it's not standard of care? Pelvic exams aren't recommended until the age of 18 or the start of sexual activity (I realize this thread started out with a male in question but has since evolved to include females, which is why I ask). Even the "turn your head and cough" exam can be performed with underwear on.

[MCatLvrMom2A&X]

Originally Posted by lorijds

At the age of 12, they should be asking the parents to step out, anyway, to ask questions about drugs, smoking, alcohol, and sexual activity, and to discuss the practice of patient confidentiality. And that's the point when they should also clarify WHY the child is refusing the exam.

I am sorry but I will never step out of the room for my dd or ds until they are to a age were they can defend themselves if needed. I will not put my child in a position to be abused ever. I have went through more dentists because of the no parents in the room policy and there is no way I will leave my child alone in a room with a stranger.

I have taken dd to the same ped since she was born but you know what the ped's in this group are still strangers to me and always will be. I dont know what sort of thing they might try to do. I dont have a feeling they would but I am not willing to risk it.

[Neldavi]

My mother would not let me be alone with a doctor at 12-13 years old and I was extremely resentful, and actually still am at 29 years old. I told her I didn't want her there and she forced herself in because she didn't trust me to be complete in everything SHE wanted the doctor to know. I was not being abused.

I realize this is different than the 12 year old who WANTS their parent there, just wanted to mention this as a confirmation of the patient confidentiality loridjs was talking about. I would have appreciated that at that age, but did not get it.

[aniT]

Originally Posted by Neldavi

My mother would not let me be alone with a doctor at 12-13 years old and I was extremely resentful, and actually still am at 29 years old. I told her I didn't want her there and she forced herself in because she didn't trust me to be complete in everything SHE wanted the doctor to know. I was not being abused.

I realize this is different than the 12 year old who WANTS their parent there, just wanted to mention this as a confirmation of the patient confidentiality loridjs was talking about. I would have appreciated that at that age, but did not get it.

In that case, your mother should have gone in, told the doctor her concerns, then left. You flat out told your mother you didn't want her there.

That is different that 1. a child who says they want their parent to stay, and 2. A child that doesn't speak up because she is shy/afraid.

If a doctor asked me to leave and I did, my daughter wouldn't say anything until we left. She would be afraid/shy to protest in front of them. She would tell me with her eyes, her expressions, but I would KNOW she didn't want me to leave. Other's may not pick up on this. So just because a child isn't protesting verbally doesn't mean the child is not protesting.

But yea.. the kid telling mom to step out is completely different. And if that were to happen I would wait RIGHT outside the door so my child knew I was close if they did need me.

[Yoshua]

I actually sorta agree that not stepping out is hindering your childs privacy with their practitioner statement. However I do not think that means a parent MUST step out.

If a parent does not want to allow that privacy, that is called parenting.


Also if the child wants some sort of privacy you can simply ask the patient 'would you like me to ask these next questions in private or with your parent present?' and hand them a list of questions you are about to ask without the parent seeing.


Problem solved, and if all else fails have hte patient write the answers down out of eyesight of parent so that it is still honest and confidential.



Many non invasive ways to ask questions if you think about it.

[Roar]

Originally Posted by aniT

I also know my child and I know her well. She would NOT discuss ANYTHING with a stranger, she would be UPSET if I left the room and she was forced to talk to the doctor herself, and she would just sit there like a lump when/if you tried to talk to her when I was not present. Hell she got pissed off because a clerk at the Van's store talked to her while I was taking one of the younger kids to the bathroom. Yes, eventually she will grow out of this, but right now she is only 13 and at 13 I don't believe she is old enough to be thrown to the wolves in the medical profession to strong arm her into doing whatever they want.

Take this for whatever it is worth, but what is the plan for her to "grow out of it"? 13 isn't three or four and if she feels angry if a store clerk talks to her if you aren't there to supervise I'd consider that a problem. Some kids really need more help and nurturing to develop independence and social competence and if it is always excused or dismissed or parents have so little confidence in their kids it can be a problem.

One thing we appreciate about our son's doctor is that from time he was five or six she addressed HIM to ask him how he felt instead of expecting us to totally speak for him. The goal is to help him develop the skills to advocate for himself at the doctor's office. That is a learned skill not just something a kid necessarily grows into. I will say that if I viewed the doctor as a "wolf" who was out to hurt the child we'd find a different doctor!

[aniT]

Originally Posted by Roar

Take this for whatever it is worth, but what is the plan for her to "grow out of it"? 13 isn't three or four and if she feels angry if a store clerk talks to her if you aren't there to supervise I'd consider that a problem. Some kids really need more help and nurturing to develop independence and social competence and if it is always excused or dismissed or parents have so little confidence in their kids it can be a problem.

Actually this is a new problem that has developed in the last year or so. And it is just around strange adults. She has no problem with other kids or teachers for the most part. Although she wont stand up for herself when she thinks a teacher is wrong, she will just "do it over cause I don't want to deal with it."

So because she hasn't "always" been this way, I believe it is a stage and she will grow out of it.

[readytobedone]

Originally Posted by journeymom

I should clarify that at my dd's 12 y.o. exam, just a few weeks ago, she did not have a pelvic exam, meaning an internal exam. All the doctor did was take a look at the vulva area to see that everything was in good shape and confirm whether or not dd had any hair sprouting yet.

WTF? why on earth does the DOCTOR need to know whether your daughter has pubic hair? seriously! that is whacked!

this reminds me...i was born with some orthopedic and bladder problems, had to have a lot of surgery as a girl and some of it involved showing my privates to doctors. some of it made sense, sure. but once my orthopedic surgeon just lifted up my underwear and looked in to check for pubic hair. supposedly, he was trying to gauge when i would stop growing so they could do another surgery. i felt completely violated, and what's worse, my parents were in the room with me and seemed to think it was fine. well, it wasn't.

btw, they never did that other surgery...i never went back to him again. i told my parents i wouldn't see him again. there is no reason to do what he did other than being a power tripping pervert. sounds like the same thing with your DD, if you ask me. i would slap a doctor who thought he needed to see my 12 year old's pubic hair status.

[BelgianSheepDog]

I don't think this has to be either/or. I am extremely uncomfortable with the idea of "routine" pelvics or similar exams for young teens. However, I'm fine with the idea of stepping outside during the exam for a child that age. Granted it's a long time before my daughter is 12, but I could easily see being ok with this. Now there are things I insist upon both for myself and my daughter that make me FAR more comfortable with this idea. One, I insist on a female MD/ND/midwife for our care. And two, I'd expect that there would be a second practitioner, also female, in the room as well when I was gone--a nurse or second CNM, so forth. I also tend to work with practitioners who are more of the midwifery model and take lots of time to get to know their patients, so there's a trust relationship.

I think that's fairly ideal, actually. Best of both worlds.

I remember starting to get peeved around age 14 that my mom insisted on being present for my exams still. I had nothing to hide from her, but it was awkward and embarrassing having to answer the sex/drugs/DV questions in front of her anyhow. Also, I adore my dh and find him to be extremely supportive and wonderful, but after a while I got weirded out that my mws never asked him to step out for a moment alone with me during prenatals. If I had a problem with him, they would have never known. Not just that, but even in a great relationship where you share everything you might want an excuse to just discuss, I don't know vaginal discomfort or whatever in privacy with a professional woman. Anyhow.

So. Anti: "routine" poking and prodding of kids. Pro: medical privacy.

[readytobedone]

Originally Posted by lorijds

As a nurse, I'm a bit insulted that some people always think that medical personnel are staying up late trying to think of ways to make the rest of you feel really horrible about yourselves.

sorry you feel insulted, but i think some doctors actually ARE complete perverts. actually, i know some are. i was molested by one when i was 13. he put his finger in my vagina in order to catheterize me (?!) and then, when i protested, he told me i was getting to the age where i was going to have to start getting used to this kind of thing.

my parents were standing out in the hall, and after he did it, he had the nerve to go out there and tell them the physical exam/'procedure had really upset me, and had i ever been sexually abused?

uh, no, i hadn't--not until i met him.

[lorijds]

Originally Posted by aniT

And what makes you think a child would tell the doctor the truth even if the parents weren't in the room? I didn't. I mean come one just because it is a doctor asking someone is going to admit to taking illegal drugs? It would be a pretty naive doctor to believe they would. Especially when they are just in there for a physical, not due to a problem.

Not all of them will, but I myself was surprised at how many did. It's not just the idea that they will tell; it's also simply giving them the opportunity to tell. They don't have to say anything; but they can if they want.

Look, you obviously have some major issues with the medical community and there is no way I am ever going to say anything right; I think we are talking
past each other at this point.

I will again say, though, that I am very much an advocate for patient rights; ALL patients, including children. As I worked for several years at a birth center that also did primary care for women, I felt it was especially important to get young women (ages 12-20) comfortable with their access to their doc/np/mw, and to help them advocate for themselves. I see a child's right to privacy as one aspect of self-determination and personal responsibility for their own health care. I'm sorry you see that as arrogant and throwing a child to wolves.

If your child's doc is a wolf, why on earth do you go there in the first place? Why have practitioner that you can't trust at all? What sort of example are you setting for her--just grin and bear it? Why not help her find a practitioner who is competent and trustworthy, so trustworthy that you would even consider allowing her some privacy with her at some point? Teaching her that she shouldn't settle for sub-optimal practitioners, but to advocate for herself, be active in her health care by seeking out a practitioner who is right for her; that seems like a better deal than teaching her that all docs are not to be trusted.

Any how, there it is. I'm sure you won't agree with me, I'm sure I've reinforced everything evil you think about the medical profession. I'm sorry you've had such horrible experiences; I hope you can find a practitioner someday you can trust.

[Roar]

Originally Posted by lorijds

Why not help her find a practitioner who is competent and trustworthy, so trustworthy that you would even consider allowing her some privacy with her at some point? Teaching her that she shouldn't settle for sub-optimal practitioners, but to advocate for herself, be active in her health care by seeking out a practitioner who is right for her; that seems like a better deal than teaching her that all docs are not to be trusted.

I agree.

And, I have to note that I've heard so many stories about people who were worried about a lump or whatever but because they don't like doctors or men who refuse a prostate exam because it is uncomfortable...and then they regret it later when it is too late to get treatment. We've emphasized with our child from the beginning the idea that there are times when private areas of your body need to be examined by a doctor. Earlier this year he had a problem with abdominal pain that could have been a hernia and I'm glad no one had to make a quick exam a bigger deal than it needed to be.

[guestmama9908]

My mother never went into my exams with me past the age of 12 or 13.

I think that it would have been a bit strange for me if she had. However, the nurse at my Pediatricians office was always trying to talk me into have a pelvic exam. I was an educated pre-teen and knew that pelvic exams in the absence of health problems were not recommended until you began sexual activity. So I always refused. She was a REALLY pushy nurse though and would hound me about having the pelvic so I started just lying to her everytime I went and telling her I was on my period so she would leave me alone. I didn't end up having my first pelvic until I was 19 years old and became sexually active.

I think that parent's need to respect their child's need for privacy with their practioner. However, I think it is important for parent's to teach their children to advocate for themselves and make sure they understand that they have the right to refuse procedures. I can also see that some children would not be able to stand up for themselves with a Doctor/Nurse so those children would need their parent there to advocate for them.

[theretohere]

I'm amazed at the moms saying they wouldn't leave the room. That doesn't give your child much of a chance to bring up anything embarrassing that's been going on.

[aniT]

Originally Posted by lorijds

If your child's doc is a wolf, why on earth do you go there in the first place? Why have practitioner that you can't trust at all? What sort of example are you setting for her--just grin and bear it? Why not help her find a practitioner who is competent and trustworthy, so trustworthy that you would even consider allowing her some privacy with her at some point? Teaching her that she shouldn't settle for sub-optimal practitioners, but to advocate for herself, be active in her health care by seeking out a practitioner who is right for her; that seems like a better deal than teaching her that all docs are not to be trusted.

My child has already been the victim of a bad doctor. Even though I trust my ND unless my daughter asks me to leave I will not. I need to make sure nothing happens to her again.

And you should never take a doctors word 100%. You need to research things on your own so you go to the doctor with the knowledge to counter with things you don't agree with.

Some people however, may not have the luxury of finding another doctor. Maybe they live in a small town. Maybe they can't change their primary care doctor. I believe Kaiser assigns people doctors. I tried to change doctors when I was pregnant and the other OB in town refused to take me because I was too far along. My reasons for switching weren't good enough I guess. I shouldn't NEED reason, I should be able to switch if I want.. but I wasn't allowed too. So as you see, not everyone can just up and switch doctors.

[pixiesmommy]

I admit, I did not read each and every reply, however, I will say that my best friend's son is 11 and also bi-polar. Going to the dr or dentist is a VERY big deal with him. They have to reasearch beforehand and find out EXACTLY what procedures will be done, in what order sometimes, etc. She also goes online and shows him pictures of things (like root canals, etc) so that he can be prepared.

Lots of people have fear of dr's, and he is still a child. I wouldn't FORCE the issue, but I would explain that it is part of being healthy and preventing disease.

I know this isn't a ready-made answer, but I hope it helps.

'Manda