Pediatric examination standards I don't understand
- 1Jul 11, '10 by ShuckI'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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- 3Jul 11, '10 by John20Testicular 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.
- 0Jul 12, '10 by Shuckthanks 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.
- 2Jul 12, '10 by eddocNo, 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!
- 9Jul 12, '10 by gr8rnpjtQuote from John20I 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.Who cares? You are waaaaaaay overly hung up on this issue. Actually you sound really weird.