Well, yeah, the letter suggests that Kim losing flute lessons is a possibility. But that is NOT the binary choice on offer, as some posters seem to be implying. The choice is whether Kim uses the in-network physician, or the whole family makes sacrifices, some apparently rather significant, such as less money being put into college funds and retirement accounts. And affecting extracurriculars for all the siblings, not just Kim.
ETA: oops, unnecessary post as DSeid made the same point more efficiently.
I don’t think it’s as clear as you believe it to be - but onto your hypothetical. No , with a household income of 80K and $5-10K over two years , and $500 month for music lessons for three kids, I probably wouldn’t go with the out-of-network doctor. It’s not clear from the letter how far the nearest in- network female doctor is, only that it’s apparently more than a 2 hour drive, so that might be a possibility. To be perfectly honest, I don’t understand how an $80K income supports 5 people pays for music/dance lessons for three kids, and saves for college for three kids and retirement so I never would have imagined that the household income was $80K.
But the specifics really do matter. I doubt it would be even $5K with my insurance, which does cover out-of-network care , and tests and blood work ordered by out of network doctors cost the same as those ordered by an in-network doctor if in-network facilities and labs are used. You didn’t mention any procedures, so I’m not factoring them in. But let’s say it is $10K over the 2 years. My household income was higher than 80K ( but not top 5%) . I spent at least $5K on vacations yearly when my kids were teenagers one year and between us, we probably spent a few thousand on clothes and entertainment every year. I spent $6K on vet care on year. What do you do in my situation? I’m cutting the vacation, clothes and entertainment budget.
And I’m saying I can’t fix that point as a general rule because there are way too many factors to consider.
Are the particular parents going to wind up divorced if they can’t get away for a date night? What sort of date night – do you mean they can’t go for a walk together or they don’t get to go to a fancy restaurant at $300 a plate?
Is one of those kids who won’t get the music lessons an actual musical genius? Or a child somewhere on one spectrum or another who can only communicate via music?
And if so, why can’t they trade those two weeks at an expensive resort on the other side of the planet instead of one of those things? Or was the family vacation that mattered so much not that sort of thing, but instead a drive to see GreatGranma, who’s 97 and fading, and who they all love; staying at a budget motel because they don’t fit in her apartment?
I physically couldn’t suck it up. I told you, it’s not under my conscious control.
The only time I can remember that situation coming up was probably 40 or 50 years ago; the doctor did a visual exam (like I said, I’ve gotten really good at holding my tongue out of the way just by using my tongue muscles) and prescribed based on what my throat looked like; which I know isn’t as accurate. These days I might suggest a nasal swab – I was able to do covid tests, nasal swabs don’t set off the reaction.
Oy. No. Stressed more maybe. Typical middle class date nights. Either a movie or a dinner that nowadays runs about $100 for a couple. Local Italian place. Maybe sushi. He likes unagi she doesn’t. Sheesh.
The point is to try to get some better sense of how much sacrifice each of think the family should make to respect (or from my perspective, indulge) this request.
FWIW out of thought that maybe my professional experience colors my perspective I presented the case to my non medical therapist wife. Who sees out of network providers all the time. Who without hesitation was on the side of the kid goes in network. She’d spend effort preparing the kid for it.
So it may be more a shared family parenting value on my part than medically colored. Our parent perspective is that an exam is not sexual and that this would in the range of “something my kid wants” like not going on the planned family vacation or getting a new computer. The kid gets some empathy but the answer is still no.
I also see other bigger costs if this child gets their way. Let’s say that a family luxury that gets cut out is the vacation. Whatever it is. Waterpark nearby. Ski trip. Shared lakeside rental house with another family. How do the sisters react to this? How does it impact the relationships they have? They don’t have her phobia. They don’t get it. They feel punished for what is their minds her being a baby.
ETA @thorny_locust - I’ve been in practice over 36 years … I’ve never not gotten the throat swab when it was needed. Including with severely autistic teens. So you must be special or I’ve been really lucky.
The thing is, we don’t know which they’re doing. We don’t know whether their date nights cost $20 or $2000, or how often they have them; any more than we know whether their family vacations are spent crashing on GreatGran’s living room floor, or flying to a luxury resort.
And if they’re spending $100 a week on date night – that’s $5200 a year. Which is a shitload of money. There are free things people can do for date night, as well as things that cost a lot less than $100.
Among the things we don’t know is that we have no idea whatsoever what the siblings think. We don’t know whether they’re going on these vacations and/or to those music lessons against their wills; or whether they like them but not so much that it wouldn’t be a big deal to drop them; or whether one or more of them is really into this specific type of vacation and/or these specific lessons.
You never had somebody you needed to have forcibly held in place, by one technique or another, because they couldn’t stop their reflexes?
And if you did but you did get the sample – do you know if they now won’t go near a doctor again if they’ve got a sore throat, for fear of that happening again?
So… you’re going to tell the siblings that it is their sister’s desire to choose her medical provider getting in the way of their vacation opportunities?
Do you do that at a family meeting?
"Hey girls, I wanted you all in the room so we can let you know our trip to Vail is going to be cancelled this year because Sally is throwing a fit over being treated by the esteemed Dr. Mann, and would rather spend all our vacation money to see Dr. Laidee instead.
Gee whiz, look at the time, I’ll let you discuss amongst yourselves."
Okay I give up. I thought maybe there could be an interesting discussion regarding how much the parents and/or the sisters should be willing to give up for this. I now acknowledge my error.
Of course I have. And the kid knows that that is our last resort option. They generally though accept the verdict of the parent that it is going to happen. You of course as an adult can just refuse. There is no nasal swab option for strep throat.
Why yes I do. Because again it happens. The kids are brought back with the next suspicious sore throat. And I’ve been at this long enough that some of those kids are now parents bringing their kids in. Often telling their kids how impressed they are at the kids ability to open wide and sharing how bad they had been at it.
Relevant to the thread actually. I don’t know where this sense that kids are so fragile and easily traumatized by doctors doing what doctors do comes from. A teen can be dramatic in the moment and be your best friend the next. There is much more resilience in the age group than this crowd thinks there is. They understand they don’t get to always make the final call. Honestly they depend on it.
If they ask why would you as the parent lie? Do you think they won’t ask? Do you assume they are too stupid to realize it?
Kids are not stupid. They are resilient. And they can be resentful and mean to each other. Especially siblings.
No, I think they don’t have sufficient resources themselves to determine what doctor for their sister’s specific and private medical issue is in network vs out of network, and what is driving the parents’ decision to select the out of town out of network doctor.
Of course they will know the vacation is cancelled due to the cost of their sister’s treatment, the question is whether they will blame the sister for it. If the parents want that, they can make it happen, and if they don’t, if they actually support their child’s choice of physician, she won’t be blamed by her siblings.
What about the kids who aren’t brought back with the next suspicious sore throat? Do you get to see them not come back? Does the parent let you know, or is your entire experience based on seeing all the successes and none of the failures?
My son’s former pediatrician made a big deal about calling him fat during a checkup. So much so that my kid started feeling really shitty about himself, and still, years later, has body image issues. That doctor never got a chance to see how his actions negatively affected my child because we weren’t bringing him back to that office. We just asked for his files to be transferred, and as far as he knows it was because of insurance, or some other random thing and maybe he thinks that making a big deal about weight is a good thing because he has patients return.
The girl’s saying she won’t see a man doctor is not something that was said in whispers behind closed doors or something that she has not shared, possibly loudly, with her sisters. They would absolutely know what drove the decision. No question.
You’ve lived with teenagers? Really?
Maybe you are right and there are parents who would be concerned about strep throat, with a child running a high fever, headache, belly pain, maybe throwing up (the classic strep symptoms) and not bringing the kid in because they really hate throat swabs. And I don’t see them because they are staying home. I personally doubt there are many parents negligent like that.
Alternatively they aren’t going to change practices over it because they saw the effort made to do it more gently. Often they were the ones saying just do it. They generally appreciate that the test is necessary for care and holding the child firmly enough to be able to get it done is required. If they are a family that wants antibiotics without being sure it is strep, well then they are indeed best off going elsewhere. We won’t do that. I’m arrogant enough to confidently state that they won’t find anyone who will be more patient in trying to get cooperation and better at the coaching attempt than I am.
Yes that is poor care. You shouldn’t accept poor care. And ideally you should have formally complained about it as well. You are probably right that the doc does not recognize the negative impact their approach had. They have zero chance of learning to handle the situation differently if they aren’t called out on in. (Now I readily admit getting docs whose approach is like that to change is hard even when they are called out, repeatedly, but some are educable.)
And here I thought I was pointing out additional interesting factors that would need to be considered in the discussion.
It’s certainly true that I’m not willing to have a discussion in which only a handful of relevant factors can be considered and all the others must be assumed to be within certain limited lines, those lines possibly chosen to result in the answer ‘of course the parents must decide for the child that she has to see a male doctor’.
Yes I personally know thousands of this family in a variety of flavors and specifics. The one that this would be something two other sisters wouldn’t be aware of what was going on? Don’t know them. Maybe they exist. I’m not convinced.
But to try to return this to some semblance of a worthwhile discussion. Do I understand correctly that as a parent in that circumstance you’d do your best to be having the discussions about the girl’s “refusing to” go to the man doctor out of sibling earshot and try your best to keep her from discussing that with her sisters? “It’s our secret.”
Sorry it read as the reasons why you would not could not engage in any discussion of it. And that’s fine.
Maybe the girl wants to discuss it with her siblings. Maybe she doesn’t. If she does, there’s no stopping her, and the parents certainly shouldn’t try to; but if she doesn’t, she shouldn’t have to.
The extent to which parents discuss finances with children varies considerably from family to family; and also, very often, varies with the age of the children. Which, again, aside from the 14 year old, we don’t in this case know; except presumably not infants too small to take lessons.
That’s a pretty ludicrous assertion. Kids hardly need a rational excuse to blame someone. Fuck, it’s entirely possible that this girl would go to the male doctor and be fully covered by insurance, and her sister who didn’t make the soccer team due to poor performance at tryouts might still convince herself that she’s not playing soccer next year because of her sister’s medical condition.
Look, if a kid has a preference in regards to medical treatment, reasonable accomodations can be made. “Reasonable” does not include going out of network and paying many thousands more dollars for care, though. Even if no one is in danger of starving or losing their home.
This is not discussing finances though, not like this is what your parents’ income is and what the mortgage costs. It is simply having heard the discussion that “we want you to go in network; out of network exceeds our budget …” “No! I don’t want a man to see my private area.”
I can accept as possible that the other teen aged girls will be on her side, especially if they are older and protective of their little sister. They may say “we want to skip vacation this year to help pay for it. She is so upset. And it is already hard for her to be the one looking like she should be in 6th grade not High School. Please?” I can imagine that. And as a parent then I’d cave.
That’s the discussion I was hoping to see: what is reasonable? Obviously that varies for each of us. And by how much we think obliging is respecting a request or indulging a want.
Suppose your 14-year old daughter wakes up in the middle of the night with acute, severe pain in the lower right abdomen, a fever, nausea and vomiting. You rush her to the only 24-hour emergency room within a two-hour drive of your rural area. Even the first-year nurse on duty can tell it’s appendicitis, but of course the only person who can confirm that is the physician.on duty. He’s male. In fact, all the surgeons in this small-town hospital are male, but your daughter absolutely refuses to let a man examine her, much less operate on her under anesthesia.
How far do you allow her to take her bodily autonomy? Suppose it were your 14-year old son who didn’t want a female doctor to see him naked?
Are bodily autonomy and informed consent really such difficult concepts?
The only difference between children and adults is that children are more likely to lack the understanding necessary to give consent. But adults are not always capable of that either (often because they’re unconscious). If a person says “I do not consent”, you need more than disagreement with their choice to override it.
How much effort and sacrifice you make really depends a lot on the health condition and the personality of the child. If this health issue just causes discomfort, then one option is to not treat it at all. It’s the in-network male doctor or nothing. If it’s something which has the potential to be life threatening, then you make more of an effort. If your kid is very emotionally sensitive, then you make more of an effort. If your kid gets over things pretty easily, then you make less effort.
I’m thinking it’s similar to counseling. If your kid was self harming and suicidal, you’d make whatever financial and time sacrifices necessary to get them turned around. But if the issue was more like your kid was lacking motivation to apply for colleges, then you’d make less sacrifice and effort towards getting them to go to counseling. The amount of sacrifice you make to get them into counseling is not a fixed amount independent of the issue and the risk to your child. And I can’t imagine framing to the child’s siblings as “We can’t go on the ritzy ski vacation because your sibling needs expensive counseling.”
The 14-year old has acute appendicitis. If the appendix is not removed it will rupture, causing peritonitis. You may inform her until you are blue in the face, but 14-year olds don’t generally have a solid grasp of consequences. Do you overrule her insistence that she wants you to take her several hours to find an emergency room that happens to have a female surgeon available?