Last week I posed a question to my readers on Facebook, “How do you feel about being asked to leave the exam room so that the doctor can talk to and examine your teenager alone?” The overall response was vehemently, “NO!” The main reason that many of the mom’s were opposed to this idea was because they felt responsible for the health and wellbeing of their children. They were concerned that their child would be negatively influenced to make immoral or unwise decisions based on the physician’s recommendation, and they also felt that they had a right to know everything about their child’s health, including sexuality. Some said that kicking them out of the room was pointless because they had an open and honest relationship with their child. Their child would tell them if they were doing drugs, having sex, or even pregnant.
As a physician, I am torn by this topic. Reading the responses from other moms was eye-opening for me. Moms do not trust pediatricians and family physicians. Which means that moms don’t trust me. Why is that? What has created this sense of mistrust? Is this mistrust warranted? Is there any benefit to having a physician talk to a teenager alone?
My opinion is that it comes down to world in life view. If my daughter were a teenager and I took her to a doctor that I had never met, whose overall moral compass I did not know, and whose opinion on sensitive topics I was not aware of, how would I feel about letting him or her talk to my daughter alone? I wouldn’t leave the room either!
However, as a family physician, I was trained to ask parents to leave the room especially during parts of the physical exam unless the teenager was okay with the parent being present. No 13-year-old boy wants his mom watching his testicular exam. And, if a mom wants to watch…well, I would question that scenario altogether. Regarding the concern for sexual abuse during a sensitive exam, all physicians are trained to have a nurse or medical assistant in the room with them. We understand liability! Not too long ago doctors only had an assistant in the room when they were examining a person of the opposite sex, but today, it doesn’t matter. I always turn on my call light to have a nurse present during sensitive parts of a physical exam.
I think that it is great for parents to have close relationships with their teenagers. I also think that it is important for teenagers to feel comfortable telling their parents all of their health concerns and asking them questions about sex, drugs, and other sensitive topics. Parents should be talking about these things with their kids. The problem is that many parents are not. Many parents don’t have close relationships with their teenagers. Many teenagers are afraid to confide in their parents. Maybe this isn’t the case in your home, but it is common. So what do we do for these kids? Should their sexually transmitted infections go untreated. Should they not receive early prenatal care because they aren’t able to confide in anyone? It gets tricky.
Several years ago I had a scenario where a young patient came from a strong Catholic background (I’m not picking on Catholics. Some of my closest friends are Catholic). He was struggling with gender identity issues and felt that he couldn’t discuss these things with his parents because they would despise him and tell him to ignore his “sinful” desires. His struggle was so great that he became severely depressed, dropped out of school, and even started to have suicidal thoughts. Although this young man loved his parents, he feared losing their love and acceptance. He had a good relationship with them, but he felt that would end if he was open about his struggle with gender identity.
This patient had good parents who cared about him and loved him. His mother brought him to his appointments each week, but as long as she was in the room he refused to share his concerns. For almost a month we didn’t make any progress as he slipped further into depression. It also took that long for me to build a trusting relationship with him and his mother. Only then did his mother feel comfortable leaving the room. Once she stepped out, the young man opened up about his struggle. He was able to admit the severity of his depression, and he was relieved that he had finally been able to share his true feelings.
What was my reaction to this and what was my goal? As a physician my primary goal was to make sure that he was safe and that his depression was under control. My other goal was to help facilitate a conversation with his family. I wanted him to be open and honest with his family. Although his parents potentially wouldn’t understand his inner turmoil with sexual orientation, he needed them to know about it so that they could love him and figure out a way to support him through his struggle. As a physician, it was my responsibility to create a safe place for this dialogue to occur. I did not have an ulterior motive. I did not have a political agenda.
As a physician my overall objective is always to first do no harm and secondly do good. Unfortunately, this is not how physicians are often viewed in today’s society. Physicians are seen as money hungry, arrogant, and misinformed. We are seen as liberal activists who only care about a greater agenda that isn’t really focused on health. We are no longer seen as a vital part of the community, instead we are often viewed as a necessary evil.
I am not sure how or when this paradigm shift occurred. If I had wanted to get rich quick, I definitely would not have gone into medicine and especially not into primary care! There are far less painful and less expensive ways to turn a profit. With over half a million dollars in student loans between my husband and myself (That will take us our lifetime to pay off), I can say that with certainty. Working 125 hour work weeks at times during residency at less than $1 per hour doesn’t make sense if you are in it for the money. Regarding drug companies, accepting bribes from drug companies is off the table these days. Most of us don’t even accept a free pen anymore. And, as for being pegged as Grey’s Anatomy characters stuffed in coat closets having sex with random strangers…trust me, in residency all you want to do is sleep. No one has time for sex (especially not the interns).
I digress…in my assessment one of the key reasons that parents and teenagers don’t trust or feel comfortable with their physicians is because they don’t really know them. Doctors frequently relocate, are in and out of patient rooms within 15 minutes, and may not be available to see their own patients because they are rounding in the hospital, covering at a nursing home, or overbooked with other patients. This lack of continuity prevents patients from developing true relationships with their physicians. And, as I said before, I wouldn’t trust my daughter with someone I didn’t know either.
So, what is my point in all of this? I don’t have all of the answers, but I do have a few take away thoughts for you to mull over.
1. Parents should be able to trust physicians because physicians should be trustworthy. Give your doctor the opportunity to earn your trust. It’s okay to move onto another physician if you find that one isn’t a good fit. It’s also okay for you as a parent to ask your physician what they would say to your child about sex, abortions, drugs etc.
2. Physicians should take the time to develop true relationships with their patients and their patients’ parents. Continuity should be a priority.
3. Physicians should understand and respect the religious beliefs and moral standards of the family unit.
4. When a teenager’s behavior does not coincide with the family’s belief system, the physician should do her best to encourage the teenager to have the difficult but necessary conversation with the parents.
5. Parents should talk openly with their children, but they should be aware that teenagers may not be forthcoming. Even trustworthy and “open” teens keep things to themselves. If they aren’t talking to you and they aren’t talking to a doctor, they are probably telling a close friend. And while peer support is great, a teenager educating a teenager probably doesn’t meet most parents’ standards either.
6. Parents should help their child identify healthy role models that they can confide in. Although we all want to be our child’s hero, thinking that this is going to happen during their teenage years is maybe just a little naive. Don’t lose hope! It may happen, but usually not until they are out of the house with their own kids.
7. Having the parent leave the room gives abused teenagers the ability to speak openly, especially if the parent is the abuser. While most children are in loving homes, some are not and the physician’s office may be the only safe place that they are able to voice their concerns.
As I said, I don’t have all of the answers because I agree with many of the pros and cons of the debate. I see the value in “kicking” parents out of the room, but I also understand many parents’ concerns. I too want to be the key influencer in my daughter’s life. I want her to come to her own decisions, but I do pray that the values I hold dear will become her own.
Mull over these seven thoughts for a moment. Most of you have already formed a strong opinion on each of them. This article was meant to generate feedback and reactions. It’s okay if you don’t agree with all my thoughts. We can still be friends, but I would love to hear your thoughts on the topic! Please leave a comment, but try not to be too hostile:)
From The Mom in Me, MD