What are the standards at your pediatrics office?

[Shuck]

Hi,

The user in the General Discussions forum suggested I get an input from some of you with the below subject. I posted the below in the General Discussions forum a while back.

So I suppose I want to get your input so I can tell the NP what the standard practices are as for how much a patient is supposed to disrobe based on gender.

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I have 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. (never a DRE) 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, unless if there is concern.

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?

[ro2878, ADN, BSN]

I'm a RN student now but was a ped med asst before returning to school. When my oldest was little (she is 15 now), the practice we went to in Georgia had all the kids undress down to underpants. Our practice now (in AZ and the practice I worked for) only has the kiddos up to age 3 fully undress. If the doctor/NP needed an older Pt to take off an article of clothing, they had the Pt just do it during the exam. I never saw any of the practitioners do a breast exam - maybe they did if asked to but I never saw it or heard of it. The drs would only do a pelvic exam if necessary for a problem. Otherwise, once old enough the Pt was referred to a gynecologist. The NP I assisted would have boy teens just lower their pants (with me in the room) to do a testicular exam. I never saw her perform a digital rectal exam. I think she was the only practitioner that would call an asst into the room for the testicular exam. I don't know what the others did.

Of course when I was little (I'm now 46!), drs always had you strip down to underpants and provided you with a tiny paper cover up that just covered your top half. Maybe it's just "old school" to have peds Pts undress!

[amandap213]

I work for 4 female younger pediatricians. They make all physicals undress down to their underwear. They check external genetalia on all patients to stage development (tanner stage). and to screen for anomalies.

[Shuck]

Any other inputs?