Wednesday, March 19, 2008

Drive-by Parenting (WARNING- LONG POST)

In all my years of practice, I have never had a fight with a parent. Never. So I guess I was due.
I’m not the pediatrician for everyone. If you want a doc who’s going to prescribe a ton of antibiotics, I’m not your gal. If you want a doc who’s going to let your kid misbehave in the office and not call you on it, or put your kid in time out, I’m not your gal. If you want to drop your 12-year old off at the office and not come in with them (at least to check them in at the front desk), I’m DEFINITELY not your gal. And that’s what happened the other day.
My assistant told me that my next appointment was here, but her Mom had dropped her off without coming in. I was flabbergasted. She was 12. 12!!! Granted, she had had to grow up quickly because her parents were really dysfunctional- her dad had died recently of what we suspect may have been an overdose of painkillers. Her Mom came in not long after that telling my assistant about her new boyfriend (a friend of her late husband’s), and all the great sex they were having—spilling all of this in front of her children!!! The girls were both morbidly obese (as were both parents), I think a combination of terrible food choices and eating habits modeled at home, and using food as a crutch to smother all their misery.

So I told my assistant to put “Sunny” in a room, but I would not see her until her Mom got back from picking up her other daughter at school. When she arrived about 20 minutes later, I examined the girl and when I was done I pulled Mom into the other exam room and closed the door. I said, “I have to tell you that I am disappointed that you dropped off “Sunny” at the front door without coming to at least check her in.” Mom responded with, “She’s growing up, and she can check herself in just fine.” I said, “She is TWELVE, and our practice’s policy is to not see children without a parent present, unless there is a note or verbal consent given. I think that is not being a responsible parent.” Mom said, “I had to get my other daughter at school!” (raising her voice) and I said, “Then you could have come earlier. I understand you think she is grown up, but she is TWELVE and YOU are her parent.” (not raising my voice, although I am beginning to shake inside a bit)

At this point, Mom starts to lose it, opens the exam room door and spills out into the hall, shouting, “I am a responsible parent! I have never abused my kids!!” Inside, I thought, “Well, that’s debatable…” but I kept my calm and said, “And I will always care about what’s best for my patients.” She responded by yelling, “I never liked you anyway!! I only brought my kids here because my daughters liked you!!!” I said, “Well, that’s really all that matters to me.” At which point she shouted at her daughter, “Sunny, do you want to stay here??!! (Sunny looked at me horrified, and I smiled at her, trying to tell her it was okay, I didn’t blame her for her crazy Mom.) Come on! We’re leaving!!” The girl looked at me helplessly and followed her Mom out.

I was shaking inside, more from pent-up anger at how this Mom was so crazy and her 3 kids were going to be trapped with all her madness until they could escape. I was also so powerfully sad that I had such a horrid example of what their life was. I am sad that I will be losing them as patients, but I am in no way sorry I won’t have to deal with their craziness anymore.


Charm said...

I am sorry to hear about what happened with your young patient. It sounds like she's had tough times, and more are ahead. :(


I always had a problem with the visits when the kids were teens, and the health care team wanted to exclude my involvement because they wanted to be sensitive to my kid's potential sexual needs. I have mixed feelings about that.

I understand the HCP's interest in giving the best possible and most complete care to its client who may be a sexually active teen. But as a parent, I am still responsible for that teen, and I will continue to be responsible for their care (including paying the bills) even if they are engaging in activities that may have a significant impact on their health, and for which I have not given my blessing. The other side of that was that I did not always feel I was given an opportunity to follow up with the doctor after such appointments, and you can't count on your teen to care enough to remember things that may be pertinent (non-sensitive or non-sexual) information to share, or to be able to regurgitate information in a meaningful way.

But from the perspective of teen sexual health, it creates a real conflict of interests when the parent is held accountable for the teen's health, safety, and payment of medical bills associated with maintaining the health status of their teen, but yet the teen is treated as an adult, and the parent is excluded when it comes to potential issues of sexuality/sexual activity. As I said, I understand the HCP's perspective on this, but at the same time, it doesn't seem right to hold parents accountable while potentially keeping them in the dark about things that could have life-changing effects for their children, and which may be contrary to the family's values as a whole.

Presumably teens also are not cognitively or emotionally ready to deal with some of the issues a sexual relationship brings into their lives, but this aspect of the health care experience could be perceived as encouraging such behavior as much as providing specific care and screening relevant to that teen's life situation.

Sorry, I got off on a tangent there. Bottom line: I am glad you insist on parental involvement as you did with your 12 y.o. patient.

I promise I won't keep visiting your blog and spamming you with my verbose commentary and opinions.

MeanMommyDoc said...

Oh, God-- promise me you WILL keep coming and leaving me thoughtful, commentary--I LOVE it.

I agree with some of what you say-- I always start my teen checkups with everyone in the room, and ask both parties what's on their mind. I think open lines of communication in families are key to healthy happy children.

I do however, when it's time, have the parent go into the waiting room and talk to the teen alone. It gives me a chance to find out about things going on that they are not sharing with their parents, and tell them all the consequencecs of their actions, in a nonjudgmental way. That will hopefully keep the lines of communication open and allow 1) them to view me as an adult whose opinion they trust, 2) me to continue to suggest good behaviors, and 3) me to serve as a bridge between patient and parent on the thankfully godawful rare occasion that some choice the teen has made landed them in a bad place.

There are all kinds of things that kids tell me in private that they don't tell me in front of their parents. If they didn't understand that I will keep their confidence, they would never tell me-- and that wouoldn't give me an opportunity to urge them to tell their parents (with my help), or at least support them as they try to make better choices.

You also have to understand, Charm, that we are operating under certain legal conditions-- they vary state by state, but MN requires us to maintain confidentiality after age 12 of issues of "sex, drugs, and rock and roll" (my words, obviously the state isn't so cool).

Thank you SO much for caring so much to leave such an involved comment.

class factotum said...

I am so glad you stood up to that mom. That poor girl needs to know there is at least one adult in her life who thinks she is worth treating properly.

Robin said...

I agree with Charm on this issue. It's very frustrating to me that schools and medical professionals are allowed to prescribe medication, make recommendations or advise my child in any capacity without my knowledge. Not because I don't trust my children, but because I am ultimately responsible. I totally agree with the whole conflict of interest issue. It potentially puts us in a very difficult position. The question of "where are the parents?" is almost laughable. I'm glad to know that you do persuade them to make healthy choices, and I hope most in your profession do so.

I remember Dave Ramsey said, on his show, he had his children sign a medical waiver or some kind of legal document giving him the right to their medical information while they are in college. His point was that while he was paying the bills, he was in charge, and he had the right to know if someone is struggling with drgus, drinking, stress, or whatever.

It's interesting to me that, in Dave Ramsey's case, the children are adults, and so can legally sign such a document. Children under 18 can't legally sign a contract. So, that doesn't work for parents of teens. Very scary when you consider this is probably the age when they are most vulnerable.