This is not my problem; I have no kids and never have. But I do like to read advice columns because I like to read about other people’s problems.
Anyway, a parent wrote in to Slate’s Care & Feeding. The article is behind a paywall so you’ll just have to take my word for it. Her 14-year-old daughter has some unspecified medical condition “that is not life-threatening but does need to be managed by a specialist.” The lass will need to see a specialist every 4-6 weeks. The letter writer states that the only specialists within an afternoon’s drive AND that her insurance will cover are all male, and the daughter is steadfastly refusing to see a male specialist because it’s not unlikely that he’ll have to examine a “private area,” which I take to be a euphemism for her vagina but I honestly don’t know, and it’s not my business anyway. The daughter is insisting that her parents drive her to an out-of-network specialist further away, which will cost the family time (increased drive) and money (increased copyas and fuel), and it’s not workable.
The advice columnist basically tells the letter writer to tell her daughter to suck it up (albeit she phrased it diplomatically and compassionately). That there will be a female nurse in the room with her, and hell, her mother can even come in with her as well. The columnist basically told the mom to put her foot down.
If I were in this situation, here is what I would do. I would speak to her doctor and nail down the consequences of just ignoring this matter* until the situation has changed – the daughter is older and has seen a gyno, for example, and is more comfortable with this type of exam. Or a female specialist has started practicing in the parents’ network. Or whatever. If we just sit on this for a few years, will she be in pain? Will she get sicker and sicker until she’s on her deathbed? Will her future fertility be compromised? Etc. I’d give her the facts and let her have agency and, if she wants to wait, she can wait. Unless, of course, the consequences are going to be dire, in which case I’d have to put my foot down.
*I’m no anti-vaxxer, by any means, and I fully trust Western medicine. To a point. But I do believe, and there’s some amount of research to back me up, that a lot of the medical care “they” recommend in the US is unnecessary. Don’t get me started on the hell I went through for a completely unnecessary colonoscopy. I can’t help but feel that a shy and traumatized 14-year-old girl is in the crosshairs of this type of situation.
If she was my daughter I might start by asking her whether she’s already had any sexual abuse? IOW, is she fearing the male doc out of buying into internet hype, or is this just basically a shy girl weirding out at dealing with her own puberty, or has Uncle Harry already played “doctor” with her 6 years ago and f-ed up her mind for life about bodies and sex and such?
How I approached everything about this case would depend on her answers. For sure I’d also want her mother in on this; heck she may not be willing to level with me, her Dad.
I don’t know how I would respond to this situation. I’m a woman, and I’ve always had male doctors, even for gynecology and child birth, though I did have a choice there at my clinic. Some women are only comfortable with other women, and I’m indifferent.
I think I’d explore the reasons why the teenager is refusing in order to make a decision. It may be acceptable to the primary doctor to have the female out of network doctor do certain examinations on his behalf, which could be a workable compromise. It could help to do a “mock visit” to show her how these examinations will take place, so she can understand better. She might be imagining something more invasive than it actually would be.
I agree that it also depends greatly on the severity of the issue, the timeframe, etc.
Might the specialist practice employ a female P.A. or nurse practitioner who could do the part of the physical exam that the teenager finds intrusive?
I’ve often seen versions of this phraseology, typically just before the poster drives off a rhetorical cliff.
I’ve observed elsewhere here that references to “Western” medical care are essentially bigoted, as they imply that science-based medicine is characteristic of Western physicians, while Eastern docs’ practices employ mysticism and the reading of entrails.
I’m not at all sure that this will matter. My guess is that the specialty in question is some sort of gynecology - perhaps a subspecialty (endocrine, urinary) but it’s hard to imagine what other sort of doctor might need to examine a “private area” occasionally.
But this -
I do not want this to impact my other girls, and it feels unfair to ask Kim to choose between flute lessons or a female doctor.
I wouldn’t want it to impact the other children either, but I’m not sure what’s so unfair about giving Kim the choice between the flute lessons or the female doctor. Channeling my 14 year old self, I would have been really annoyed if I didn’t have the choice just because my parent thought it was “unfair” to give me the choice.
I’m wondering if her primary doc is a male who made the decision to refer her to a specialist and she is already uncomfortable with that particular physician
I would include my daughter on choosing a specialist in network first. I’d ask the pcp office for their opinion in general. Then I’d look up the offices of the in network specialists, review their patient feedback reviews and give them a call sharing my daughters concerns and how they handle treatments and exams for children. There could be miles apart in sensitivity training for young patients.
I would not interrogate her for any sexual hang ups or even hint in anyway her disorder is her fault for being shy and private.
Yeah. It really doesn’t read like ‘we can’t afford to go out of network, we’d go hungry or be out on the street’; it reads like ‘we can’t afford to go out of network without giving up something else reasonably optional that we’re used to paying for.’ (not direct quotes.) And it makes total sense to me to put it that way to Kim – “if we pay out of network for this, we can’t afford to pay for your music lessons. Pick one.”
– the article linked does also say that they’ve considered the abuse issue and the 14 year old denies there having been any such; and told her that her mother and/or a female nurse can be in there but that doesn’t help; and that “foregoing medical care is out of the question”.
My controversial answer to this is: The Lil’wrekker did this at the time of her first gyno appointment. She was 15
Been having many many issues monthly
Complaining and wanting more and more pain relief, I couldn’t get her. Wouldn’t get her. Every month. Then the week before became awful for her.
I made her an appointment with a gyno suggested by her pediatrician.
She flatly refused when I told her what would happen.
I called the pediatrician. She prescribed her 3 valiums.
And told me, just do it. She’ll get trough it with fewer tears and not be permanently traumatized. I stayed in the room with her. She did fine.
I know drugging is not the best way. But it worked.
She has no problems going in now.
I’d probably do whatever is necessary for her to feel comfortable. That age is a pretty awkward and confusing time for kids. If she doesn’t want a male doctor, that’s a reasonable request. She may eventually tire of the long drive to see a female doctor and decide to see the closer, male doc. That would be her choice. That would allow her to feel more comfortable with her body and gain confidence.
In the absence of any kind of history of abuse as suggested by @LSLGuy – which factor would make a huge difference in how I responded to the situation – in general I have no patience with this bullshit. A few years ago I was in the reverse situation – a male with a female doctor – and as luck would have it, an examination of Private Parts™ was needed. She asked (a) if I’d be more comfortable having her colleague, a male doctor, do it instead, or (b) if I’d like to have someone else in the room during the exam. I just basically said, FFS, just get on with it. When it was done, it was like the equivalent of a doctor saying “stick out your tongue and say ‘ahhhh’”. It was a non-event. I can’t even understand why people get so worked up about these things, although it’s been a long time since I was an adolescent surging with hormones and insecurities.
You know what I think? I thonk the whole scenario is made up because some perv gets their jollies getting people to talk about 15 year old girls having “intimate examinations”. They like getting women to give details about their own experiences as teenagers with older male doctors. They like hearing people speculate about 15 year old girls being pressured into intimate situations wirh older men. They like people talking about sexual abuse of children, or by doctors.
I mean, maybe its real, but the story seems too perfectly balanced to prevent any actual compromise, and the internet has made me so very cynical.
I can’t understand why people get worked up about football games they’re not even playing in, but I understand that they do.
I had no problem with a gyno exam by a male doctor when I was 14. (Though he only did an external exam, because I was 14; due to which he missed something, though that was only a minor problem that was discovered later.) But that doesn’t mean it’s not a real problem for some other people.
A fair number of teens, boys and girls, have anxiety about a genital exam by the opposite gender.
In a general practice there is often the option of making the appointment with a same gendered physician, or deferring the genital (GU) exam as not absolutely required for care. But not always. There are acute care visits when only one gender provider is in office at that time that require a GU exam. 99% plus of the time we can talk kids through it.
The specialist is I am sure very well practiced at dealing with these sorts of anxieties. If a general practice can successfully deal with most of the time I am sure the specialist can with even higher success rate.
I should rephrase that. I do understand it. I also think it’s stupid.
I’m reminded of a line in some movie whose title I don’t recall. A female nurse is trying to undress a male patient who is pushing back. The nurse says, “if there’s anything there that I haven’t seen a thousand times before, I’m going to beat it with a stick!”
No, I’m certain that the line I remembered was “… I’m going to beat it with a stick” and was from a feature film. Apparently one plagiarized the other, and I think it was a pretty old movie, so I think the movie came first!
Could be. Let me know if you remember the movie (could be independent invention - I’ll bet nurses have been using that line or its equivalents for some time)
