Pediatric examination standards I don't understand

  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?
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    About Shuck

    Joined: Jun '10; Posts: 10; Likes: 4


  3. by   elizabeth321
    why don't you ask her.
  4. by   Shuck
    I did, but she just said that it is the way she has always been doing it.
  5. by   John20
    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.
  6. by   Shuck
    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. by   John20
    Who cares? You are waaaaaaay overly hung up on this issue. Actually you sound really weird.
  8. by   sam4cnm
    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....
  9. by   eddoc
    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!
  10. by   gr8rnpjt
    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.
  11. by   Shuck
    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.
  12. by   Batman25
    Is it possible that the actual MD (pediatrician) is doing the genital and breast checks during their yearly physical? It wouldn't necessarily be part of the exam needed for a sports physical but should clearly be included in the yearly physical. Another explanation could be the teens are being seen by a gyno as well as a pediatrician but I would check to be sure. It would be highly unusual to have no checks in female teens unless they know they are being seen by a gyno as well. Ask the MD in the office and make your concerns known if needed. Could be the result of poor communication between the two with both thinking the other is doing it.
  13. by   tbrd450
    Let's not make this more complicated than what it truly is. This is wrong. This is just yet one more example of the double standard against male patients (boys and men both) when it comes to modesty consideration. Females are typically overprotected, and males are universally under-protected. A testical squeeze here, an anus exam there, an open exam room door here, a team-effort catheter installation there.... all within a cross-gender environment.

    Just ask if the reverse exam were to occur -- on girls, by male providers -- (routinely strip down to underpants)....

    well... it's too obvious to even debate. You either get this or you don't.

    You are not weird. You are correctly picking up on a double standard. I don't know what is motivating the nurse who does this medical provider "because I've always done it that way"... probably, just because she can -- she can get away with it when the cross-gender patients are male.

    Incidentily, while I'm certainly not comparing this directly to Abu Ghraib, it is worth noting they humiliated and degraded detainees only so far as they were male. They did so because they could. They knew the public outrage at learning of that stuff happening to female detainees would never be tolerated -- but, as long as they were male...well... you get my point.

    Double standard. Men and boys on losing end.
  14. by   advo-kate2
    i commend you 'shuck'. not only for being brave enough to ask the questions that need to be asked, but for having the backbone to approach a provider for answers.
    i think most of us by now have read enough research that speaks to this provider's attitude. the "old way of thinking" leads to millions of boys becoming men who do not seek healthcare.

    good job!