Pediatric examination standards I don't understand

  1. 1
    I've been working at a private pediatric office for a couple months or so after I got my nursing degree. During spring/summer times, there are a lot of teens coming in for sports physical or just a general physical.

    The practice consists of all women. I work with a nurse practitioner, and most of the time, the NP does the sports physical. What I didn't understand was, that when a female comes in for a physical exam, she just tells her to remove her shoes and socks, but when a male comes in, she tells him to undress down to underpants.

    Of course, for a male, the examination includes a hernia exam, so she asks the patient to remove his underpants towards the end. She also does a brief visual check of the anus. She also examines the testicles and retracts the foreskin if the patient is uncircumcised.

    For a female, she keeps them covered except for the parts that are being examined, but she does not perform a breast exam or a genital exam.

    I just couldn't understand why she differentiates how much a patient disrobes, and what parts of the body is examined based on their gender. Adolescent females are not immune to growth abnormalities either.

    I would provide both patients, regardless of gender, a gown, and not omit any part of an exam, just because of gender, but apparently, the NP that I work with has a different view on things. She is in her 50s, so maybe she has an old way of thinking.

    Is this practice standard?
    tbrd450 likes this.

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  2. 38 Comments...

  3. 0
    why don't you ask her.
  4. 0
    I did, but she just said that it is the way she has always been doing it.
  5. 3
    Testicular cancer highest risk group is teen to 35 in males. A testicular exam is important but even more important is teaching the boys to do their own every month. Nobody knows what their testicles feel like better than a teenage boy(trust me, I was one) himself so teaching him to look for abnormalities is almost as important as checking the rate and rythym of his heart. If there is a hernia the intestine can drop down into the scrotum cutting off blood supply to the intestine. It's rare, but nobody wants a colostomy when they are in high school.

    I've probably had 20-30 docs or NPs of all ages and sex check for hernias on me in my lifetime between sports physicals and moving from job to job. It really isn't traumatic.
    GrnTea, Altra, and BluegrassRN like this.
  6. 0
    thanks for the reply, I know importance of hernia and testicular cancer screening in males, but it seems like she over protects the modesty of adolescent females and omitting important criteria, such as checking developmental issues. It is not like females are just that much more immune to growth problems.
  7. 3
    Who cares? You are waaaaaaay overly hung up on this issue. Actually you sound really weird.
    r.dav, sharpeimom, and traumaRUs like this.
  8. 10
    Probably because the NP expects teenage girls to see an OB/GYN or specialist for that care whereas male patients only have their primary care practitioner. Just a thought....
    GrnTea, diva rn, ~*Stargazer*~, and 7 others like this.
  9. 2
    No, I'm sorry but she is not providing the young women with the standard of care. Although less common, females can have inguinal hernias and one cannot do a good scoliosis check while fully dressed - and that's just for starters. She is doing her female patients a disservice - especially if she is billing for a complete examination!
    kakamegamama and morte like this.
  10. 9
    Quote from John20
    Who cares? You are waaaaaaay overly hung up on this issue. Actually you sound really weird.
    I think it is an important question. You didn't need to go there. It is a standard of care issue and needs to be discussed.
    zofran, BrazoriaLVN, diva rn, and 6 others like this.
  11. 0
    thanks. I just didn't question the NP further since she is condescending and I rather not argue with her since I have to see her every day. Maybe I need to find a job at new office, or maybe I am too sensitive.

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