An example of an immediate life-or-death situation is not the same as a health condition that needs periodic treatment every 6 weeks. The decisions you make in the moment when you’re trying to save your child’s life isn’t really the same thing. But there are real-world examples of this playing out. For instance, there are religions which have very strict rules about medical treatment. In some cases, they will refuse medical treatment for their child if it cannot be done in accordance with their religious practices. In some cases, the child has died. So I guess for those kinds of people, if their religion said that only a certain gender could treat their child and a doctor of that gender wasn’t available, they might refuse treatment even if that meant their child would die. But I think that’s an extreme situation. For most people, they would make the decision to have the treatment no matter if the doctor was the preferred gender or not.
Mea culpa, missed that.
Yeah, that’s one of the possible factors I’d consider.
That’s an entirely different situation. The child’s in imminent danger of dying. There’s no time to drive further to see a different doctor – which clearly is one of the options in the case being discussed here.
Suppose that emergency room is out of network. Are you going to stand there in the emergency room, with the child in imminent danger of their life, and discuss whether it’s worth giving up the family vacation in order to get them treated by an out of network surgeon? I sure as hell hope not.
Presuming the degree of urgency is the same, then that is the same example as the case being discussed. Switching the genders doesn’t change anything about it.
You seem to be in a state of some confusion about which situations are analogous and which aren’t.
The scenario you responded to was a child who is refusing treatment for appendicitis because they don’t want a doctor of the opposite gender to look in their no no zone. Just so we are clear on what is apparently not supposed to be a complicated concept. Consent is consent; if you inform them that they will likely die unless treated, and your 14 year old says “eww, I’d rather die than have a male doctor look at me”, then I guess you gotta start saying goodbye.
The consensus seems to be that in severe enough circumstances it’s acceptable for a parent to override a 14-year old’s wishes, no matter how strenuously shee (or he) objects.
Now all we have to decide is how much time and money it takes to be severe.
I’ll go back to what I proposed way back in post #48.
Split the problem into two components. 1) Is she afraid to have a male doctor because she’s been sexually abused? Have a trusted third party (not her mother) talk with her to establish if that happened. 2) Is she just shy, or worse, just being a 14-year old? Then she’s old enough to be told, “We can pay for option A, but if you really want option B, we’ll have to skip your flute lessons to pay for it.” She’s old enough to understand the choice.
Pull out from this child’s preference for a female doctor: the issue of assent in pediatrics for care is not simple.
There is much more to psychoneurocognitive development through childhood and adolescence than increased understanding, although that is a critical factor in medical assent. The maturation of judgment capacity is also at play. They make decisions differently than adults do. The prefrontal cortex and limbic systems are works in progress. A fourteen year old has more capacity for medical decision making than a ten year old does but they do not have adult capacity or even the same capacity they will have at 16. Even if they intellectually understand all the issues. The parent (or guardian) ideally increasingly involves the child as they mature but ultimately they remain the decision maker … within limits. The state also has an interest to protect a child from serious harm. Relevant to this discussion is the concept of “constrained parental autonomy” - a parent is allowed to consider the “best interest” of the child and the family’s best interests as well, so long as the child’s basic (medical and other) needs are met. And the child’s voice in that process is important but not absolute. It is nice to get assent but if a procedure or treatment is required, if saying no is not an option, don’t bother to ask the child.
Yes appendicitis is a great example. Treatment is required. No assent is asked of the child and if they don’t want care too damn bad. But it is still nice to give them control over aspects that they can have control over - like what arm gets the IV.
And it gets more complicated. There are circumstances for emancipated minors for example.
TLDNR versions. Kids are not just small and less knowledgeable adults when it comes to medical decision making.
Yes, but parents are generally allowed to consent on behalf of their 14 year old children. And as @DSeid points it, there are good reasons for that.
Absolutely. That’s why the mystery condition that absolutely has to be treated but doesn’t sound deadly is suspicious.
And the “absolutely no way to get a female practitioner in network” is suspicious. Yeah, for appendicitis, you get the or physician who happens to be there. For a series of planned appointments?
For something like issues with puberty? A specialist hasn’t trained someone of the other sex to do exams on squeamish patients? (Using consenting, less squeamish patients for the training, of course. Speaking as someone who often consents to let trainees do stuff, i don’t think that’s super hard to arrange.) Not any of the specialists within a 2 hour drive?
Seems to me this is the thing.
If you have the time and ability to get a doctor of a preferred gender then great! Do that.
But you (general “you”) may not always have that choice. Maybe you live in a rural area and the only doctor within 50 miles is a guy. Deal with it or drive 100 miles to get to a female doctor. But, if you need critical care immediately, you get who you get and are happy for it.
If she is able to choose then great…she absolutely should pick a doctor she is comfortable with. I’m just not sure such a choice is always possible.
Remember Larry Nassar and all the female gymnasts he “examined” in an invasive totally predatory way. I have known several women who’s abuse happened by a doctor. Young girls are that kind of predator’s prey. I would honor her vulnerability in this situation and teach her how to be an active participant by helping mom to research and interview doctors and medical procedures. If this is such a big deal for her, this is an opportunity for her to be empowered to be a part of this decision about who touches her body–medical now, personal sometime later. This time in a girl’s development can set a lot of precedents for her adult life, and each parent/child needs to go thru this “rite of passage” on an individual basis, based on so many of the things other people have mentioned above.
Hence:
I’m willing to bet that the vast majority of 14-year-olds who have never had a genito-urinal exam get freaked out about the very idea. They’ve spent their lives covering that area and getting warnings about Chester Molester, and now suddenly they’re supposed to uncover and allow a stranger to peer at their genitals? Noooo! And wait, the person peering is the opposite sex? NOOOO!
I’ve taught 14-year-olds and have raised three. I wouldn’t confront, cajole, or strong-arm her. Those are awful tactics. I also wouldn’t guilt her. (“You’d be depriving your sisters of the vacation they’ve been dreaming about for months.”) And I definitely wouldn’t look for a way to manipulate her.
First, I’d call the office and make an appointment for her to meet the GYN and his nurse, NP, or PA. No exam, just a get-acquainted appointment where she can ask and answer questions of any of them, and maybe learn that a staffer who’s female can do the exam. As DSeid said, it almost certainly wouldn’t be a pelvic exam, and hearing that from them could help her.
As those who have raised or are raising teens know, they often respond better to information and encouragement from people who are NOT their parents–an older sister, maybe, or a cousin.
A third possibility would be going to an out-of-network female doc for the first time or two. Once she’s comfortable with that, she could reevaluate the possibility of going to the male doc.
Maybe she can’t make the decisions on her own, but she can and should be part of the search for solutions.
Does insurance cover that? Maybe you can afford such a thing but not everyone can.
Cheaper than flute lessons.
Very much yes.
The pediatric workforce has a worsening shortage in general; the pediatric specialists workforce is in crisis. Pediatric endocrinology availability is hit from both sides.
For all of the pediatric specialties it’s bad: relatively low compensation for the years of training required does not a big pipeline make and practicing docs are retiring. Pediatric Endocrinology though has also been hit by increased need at the same time (more pediatric diabetes, more cancer survivors with endocrine disorders, more kids with metabolic syndrome from other medications, their need for involvement in transgender care …)
They also are not a big revenue generator for academic centers. Not a lot of procedures. Not many admissions. Not a bunch being invested to support them. The bean counters will hire specialty trained NPs to help out with the diabetics and relieve some of the load, but not just to deal with a girl’s anxiety about a man doctor seeing “her privates”. Those NPs are fully booked doing that.
If this is a true story, and it sounds real to me, and the condition is something like Kallman syndrome as I’m guessing, it really needs an experienced academic endocrinologist. They need to do their own exam in any case as a matter of best practice and they don’t have a lot of support.
Real world. An NP coming in to report to the doctor second hand what the exam is to spare a squeamish patient from having a man doctor see them is not going to happen.
I can one hundred percent understand why a 14-year-old girl would get worked up about this sort of thing.
I am legitimately surprised at the lack of support for the kid in this thread.
There’s support, and there’s support.
There’s making reasonable accomodations when the costs for doing so are not immense.
There’s guiding your kid to learning how to overcome their discomfort so they can function in society, something they’ll need to learn to do by adulthood (although sadly I see far too many adults who never learned to do this as kids). Because adults sometimes have to do things they don’t want to do.
If the parents just didn’t feel like taking the extra time out of their day to drive a little further, I’d say they are being assholes. But going out of network and paying thousands more? There are limits.
I want my children to grow up to be resilient, adaptable people, who can deal with whatever situation the world throws at them in a practical matter.
Obviously, your kid being super worried about this could be a sign of a big problem, for example abuse. So it’s not something to be ignored, or brushed aside. It’s definitely something to be engaged with, and worked through, with compassion and empathy.
But compassion and empathy doesn’t mean “you get whatever you want no matter the cost”. It doesn’t mean that when you’re making decisions for yourself, either. And part of the reason that I’m emotionally capable of denying my own wants for long term benefit today is that my parents knew when to tell me “no”.
The idea that only the people who capitulate to their kids’ every whim are being “supportive” is ridiculous. You support your kids by doing what it takes to raise them to be functional adults, not by coddling them until they’re 18.
I am not a kid, and perhaps it’s regional. But my real world experience is that in the past 10 years I’ve been aggressively offered a “female” option for everything remotely related to sex. To the extent that the named male dermatologist i had an appointment with literally relied on his trainee to examine my crotch rash, as best as i can tell because he was squeamish.
I completely understand that teens get worked up. There are boys now who get worked up about being seen by another boy in the locker room. Grown men who are freaked out about the other guy comfortably changing in front of them. Boys uncomfortable with a man doctor looking at “their junk”. Yes the discomfort of a teen girl already anxious about her body having a man see “her private area” is very understandable and empathy is appropriate.
Supporting her through the process is appropriate. Imposing significant costs on the rest of the family OTOH is not.
Nope not regional. Nationally. Yeah you not being a kid is key here. Completely different workforce issues.
Especially when we mostly agree that it’s a decision to be made after considering the benefits and consequences of each alternative.
Nobody (I hope) would hesitate to choose the female practitioner if it were just slightly more inconvenient.
Nobody (I hope) would fail to allow the male practitioner if it were a matter of life or death or if it were simply impossible to successfully use the female practitioner (time/cost).
This situation is somewhere in the middle, and folks on both sides are being very locked in on their choice as if we all know where in the middle it falls. As if we know how much and exactly why the girl doesn’t want the male practitioner, and how much choosing the female practitioner will impact the family’s life.
Where I’m going to be firm, though, is in stating that choosing a female practitioner is not “coddling”. It’s being supportive. There may be many times when that supportive choice is just not a realistic option, and can’t be selected, but when it is a viable option, you aren’t making your kid soft by letting that be the choice.
Are you reading anyone taking that position? That the family making any sacrifices to avoid the male doctor should be avoided in order to not make her soft? You misread @Babale if you think their post says that. Or anything I’ve written.