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Marginalizing parents

This article in the Washington Post struck a nerve. A pediatrician writes of how he struggles to provide quality care to teenage girls but the mothers of these girls won't give him the privacy he needs to ask the tough questions about sex, drugs, abuse, and other sensitive issues. And then when information comes to light about a sexually transmitted disease or pregnancy, he cannot share this information with a parent unless the minor girl consents.

I empathize with his dilemma. In my years of practicing medicine I have faced many similar dilemmas. A mother brings her daughter in for what she thinks is the stomach flu. I run a pregnancy test and it comes out positive. The law says I cannot tell Mom this result unless her daughter gives me permission to do so. This right to privacy extends all the way down to twelve-year-olds.

I know why the law is there. Parents can be intimidating and in some cases there may be a risk for abuse. However, in the vast majority of cases, parents love their children and want only the best for them. They may be angry. They may be hurt. But they still love their kids. In fact, no one loves their children more. No one wants to help their children more. A daughter in a crisis pregnancy may be so afraid of the anger and disappointment that she cannot anticipate the love and support that will follow the initial shock. Is it right for the law to stand between a child and parent at a time when a child needs her parent more than ever?

In this article, the physician really does want to include parents in the management of a teenager's crisis pregnancy. Unfortunately this is not always the case. Some doctors, nurse practitioners, and physician assistants are on a mission to make sure their young female patients know that they can get birth control pills without their parents knowing. I have heard from many young women about how they have been badgered in the exam room by a health care provider who is anxious to help them get around what these zealots see as oppression of free sexual expression.  If these young women state they are virgins, the providers encourage them to feel free to explore their sexuality. Maybe if they don't have a boyfriend it is because they would prefer a girlfriend? It's all good! One nurse practitioner actually suggested to a young girl that she wear a bra that showed off her breasts more.

So as a parent, what do you do? Do you stay or do you go when the doctor asks for privacy? Here is what I did. Since our medical care was in military facilities, we were never able to establish a long term relationship with a health care provider. As a doctor, I know it is more comfortable to ask a young girl about sexual activity when her mother is not in the room. And it is a question that must be asked. So I gave them that privacy. But I also tried to prepare my daughter for this solo talk.  I told her that the doctor was going to ask her if she was sexually active. The doctor might offer her birth control pills. I explained that the doctor may be used to seeing young girls who engage in activities we have told her are wrong. He is taught not to judge the morality of his patients' actions so he is trying to offer any and all care she might need. He has no way of knowing how strong our relationship is so he might not be anxious to include me in the discussion of these sensitive matters. I also let her know that there was nothing she should ever feel she had to hide from me. Nothing would ever make me stop loving her.

My daughter had many of these one-on-one talks with health care providers over the years as she got her yearly sports physical. Some were innocuous. Some were obnoxious. I think having prepared her beforehand helped her to be ready to answer the questions honestly and not be surprised by the very blunt and sometimes embarrassing discussion.

Medical training focuses on getting the right information and providing the right treatment. When the parent is needed to get a history, doctors are happy to include them in the process. However, I know my training treated parents as an obstacle to care instead of as a partner in care as the children reached adolescence and on in to their teenage years. In most cases this is just wrong. Do we really have to assume parents are the enemy when in most cases they are our greatest ally? Is it right to marginalize all parents because occasionally there is a parent who cannot offer appropriate support to their child?

What has your experience been? As your children get older, do the health care providers assume you are a loving parent or do they treat you as if you are a problem for your child?


Comments

Barb, ofs said…
I was unprepared for the Red Cross people to kick me out when it was time for my daughter to give her medical history before giving blood.
I was unprepared for the pediatrician to confront me in front of my daughter about whether she should have Gardasil. I think that conversation would have been better between parent and doctor without child present as it served to drive a wedge there (after all, parents know nothing and they are overprotective and not cool. Like she needed reinforcement of THAT line of thinking.)
RAnn said…
I had to laugh this year. My teen daughter's doctor told me some time ago that physicals would be sans mom in the future because she was entitled to her medical privacy. She brought a note home from the school nurse saying she needed a shot so I sent her to the doctor after school (the office is close to home) for a physical and shot--after confirming that I did not have to be present (didn't see how me in the waiting room would be helpful). I'm sure they would have given her an RX for birth control without batting an eye, but they called me to confirm that it was ok to give her the shot required for school--and told me they only took the verbal ok because they knew me.
Tony said…
My wife was the one to accompany our girls to the doctor, and they all pushed Gardasil. We and our daughters didn't feel they needed it, and we resented the implication that our girls couldn't control themselves.

We have always held our daughters to a high bar, and knowing they could reach it was a big part of them doing so.
Denise said…
RAnn, not only would they have offered birth control pills, but the could also have inserted an IUD. Under the HHS mandate of Obamacare they will be able to arrange for sterilzation at no cost to your daughter without notifying you as well.
Michelle said…
The civilian doctor we just left didn't ask me to leave during the kids' physicals and didn't act like I was an overbearing mother - but my boys are only 12 and 14...and the girls are still young - 9 and 11. I'm sure things will get more difficult in the next few years. I like your plan! I have much bigger issues right now with the baby's doctor who wants him to gain weight at a rate in line with a formula fed baby, not a breastfed baby (a younger, female doctor, too). I'm giving him one bottle (4 oz) a day because just that little amount is putting him into her range of weight gain and I just want her off my back.
Denise said…
Michelle, let me guess--your young doctor has never had kids. I had my first child after I had been practicing medicine for about a year. At that point I realized Nelson's textbook of pediatrics had never had children. I was ready to throw it out the window. I also felt terrible because I had been advising mothers about what was best for their children and after having my own, I realized how clueless I had been!
Michelle said…
That's my guess, Denise. I think she's pregnant, but it's hard to tell during that 2nd trimester and she was wearing an AF uniform, which is not exactly body skimming. So there's hope...and I've been there too - haven't we all had our "perfect parent" moments all before we actually were parents? What bothers me is that I - a mother of 7 who has been through all this and more - was still questioning myself in thinking that maybe he wasn't gaining enough, until I got home and triple checked my sources. I can imagine how hard it would be for a much younger and less experienced mother. And then we wonder why so few women stick with nursing their babies!

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