Pediatric examination standards I don't understand

[Shuck]

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 orifice. 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?

[Shuck]

I am a nurse for a np also she preforms physical on all types of ages and all males are completely nude . As a woman it brothered me at first I have to be in their. But now it ok I know I have a job to observe . But it has to be done

So females stay dressed? or they get to keep some clothes on?

[talaxandra]

Statistically, females have a higher incidence of inguinal hernias than males.

Um, no: "Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women." (source)

[CP2013]

My dad has gone into physical exams with me when my mother was unable to. I never had a problem with it because I was in a gown and knew my parent (regardless of gender) was present to ensure I was examined thoroughly and without incident. This was until I was probably 17? I was never uncomfortable about it.

That said, I never had a pelvic exam until 18 years old at the OB/GYN. For this, no one was present.

I am sorry for what happened to you, but what would happen if your daughter was being molested by the provider? How would you ever know? Your daughter would probably think this is normal practice. Do you see what I am saying?

My parents never "stared" but their presence alone made me feel more comfortable. As an early bloomer, my mom explained to me that the doctor would have to touch my breasts. That freaked me out! But knowing my mom was there made me feel like this was a normal part of the exam. I had the same doctor for ages 7-17, an the same one from 18-now. I have a relationship with these providers and trust them, but I am thankful for the role my parents played in ensuring that I was safe and well cared for.

Also, providers would ask that you schedule a ANNUAL physical so they could perform the entire exam. Perhaps some of the female patient's are only requesting a SPORTS physical. With my insurance, that exam is not as thorough. Do these girls have an OB/GYN to assess them for pelvic or breast disorders? One cannot assume that all adolescent female have an OB/GYN to do this. Some do go because their primary will not prescribe birth control pills or other options.

I know this is an old post and OP hasn't been around for a while but I would be interested to know what her job title is/was and how this all played out for the practice overall.

[banterings]

I know that the last post was a while ago, and I know that people come back, that is why I am posting this. Unfortunately, hind sight is 20/20.

This is NOT normal, unless you are working for Dr. Twana Sparks...

Twana Sparks, MD, the ENT surgeon who for years allegedly performed genital exams on male patients while they were under anesthesia, without their consent, is back performing sur- gery at Gila Regional Medical Center in Silver City, N.M...

The unauthorized genital exams and the doodling went on for years. And nobody said or did anything about it.

Until July 17, 2007. That's when Alison Garner had seen enough and couldn't keep quiet any longer.

According to Ms. Garner, who administered the anesthetic for this case, and another witness, Dr. Sparks, then chief of staff at the hospital, had just finished performing a tympanoplasty with mastoidectomy on a Hispanic male in his mid-30s. After applying the dressing, Dr. Sparks threw back the covers on the patient, reached into the fly of his boxer shorts, pulled out his member and held it in her ungloved hand toward the ceiling. Dr. Sparks noticed fluid-filled vesicles indicative of a sexually transmitted disease on the right side of the shaft and yelled, Oh, gross!” She then slapped the head of the member 3 times to shouts of, Bad boy, bad boy, bad boy.” The all-female OR team laughed. All except Ms. Garner.

Unable to sleep that night — I have somebody who's asleep on the table and I'm supposed to be their advocate and I didn't do anything and didn't say anything?” — Ms. Garner says she reported what she says she saw Dr. Sparks do the next morning to Mark Donnell, MD, the director of anesthesia, who, according to Ms. Garner, laughed and said, Oh, wait, is Twana doing one of her exams again?” Source: Outpatient Surgery "The ENT Surgeon Who Gave Genital Exams"

If there is any doubt on the Twana Sparks story, here is a link to it on the National Institutes of Health:

The OP may very well be witnessing abuse.

[banterings]

UPDATE: hernia exam NOT necessary, actually causes more harm than good.

the American Academy of Family Physicians' web site (Health Maintenance in School-aged Children: Part I. History, Physical Examination, Screening, and Immunizations):

Physical Examination

A full physical examination should be performed during any health maintenance visit, and is required in a well-child examination for insurance billing. However, one study has shown that physical examination in an asymptomatic, school-aged child will find a new abnormality in less than 4 percent of patients, and most of these abnormalities are not clinically significant.5 Few specific examination elements have been validated as having a positive or negative health effect. Because more than 1 million abused children are identified annually in the United States, physicians should remain alert for signs of abuse.

Screening Tests

Screening recommendations for school-aged children from the American Academy of Pediatrics (AAP) and the U.S. Preventive Services Task Force (USPSTF) are listed in Table 1.3.

[COLOR=#cc0000]The USPSTF recommends against scoliosis screening and testicular examination in asymptomatic patients because these tests have been found to be more harmful than beneficial in these patients.[/COLOR]

Here is the footnote for that reference: U.S. Preventive Services Task Force. Screening for testicular cancer. February 2004. Recommendation Summary - US Preventive Services Task Force