mgriffiths Posted February 10, 2022 Share Posted February 10, 2022 Curious how others have handled these types of situations, because I am in shock at my current employer. I am an ortho PA, but during one of my "redeployments" to UC (a separate issue for another time) I had a mother bring her 11yo son in for a sports physical to play football. On the sports physical form a genital exam is required for contact sports for a hernia check and to ensure the presence of two testicles*. The patient in question declined the testicular exam. I counselled the patient on the requirement and that I could not sign off on his form if he didn't have the exam, and therefore he would not be able to participate in football. He decided against the exam and was fine to not play football...his mother lost it. She tried talking him into it, but he continued to decline. She then tried to get me involved, obviously wanting to force him to do the exam, offering to hold him down for me. I declined stating it was his choice and if he changed his mind he could return to complete the exam in the future. To put it simply...his mother was having none of it and this resulted in a complaint to admin. To make clear: he had no medical concern, neither did the mother. This was ONLY to participate in football. The complaint resulted in a meeting with administration as they felt my decision was inappropriate. Following protocol I requested a provider hearing, which is a meeting with admin and subset of providers to give clinical input. To put it simply, I was astonished to hear colleagues (male and female...MD/DOs, PAs, and NPs) stating the genital exam should have been completed per the mother's request. I asked whether hymen checks should be performed at a parent's request to confirm virginity and it was a resounding NO. Furthermore, a local college's athletic form requires a female genital exam (for unknown reasons, we've tried to have them remove it but they refuse) and it is our policy to not complete the genital exam unless the patient has a medical concern. But, for some reason a testicle exam on a male against the patient's wishes without medical reason is ok? To me this would be grounds for medical battery, and possibly could even be construed as sexual assault...but I'm not a legal expert. The result of the hearing was that I did not meet "standard of care" and therefore would have a "formal reprimand" placed into my file. I am flabbergasted to say the least! I am in the process of appealing and looking into my options, but curious for input on whether others would have performed the testicular exam. *I am aware there is question regarding the utility of testicular exams for sports physicals, but it was on the form and I'm not going to put my signature on something without completing the requirements 1 5 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted February 10, 2022 Share Posted February 10, 2022 Griff, You work with morons. Despicable morons. 2 1 9 Quote Link to comment Share on other sites More sharing options...
LKPAC Posted February 10, 2022 Share Posted February 10, 2022 I probably would have written "declined" on his form under genital exam and signed off anyway. Then I would have a detailed note in my chart as to why and that I explained the potential dangers to mother and patient. 3 8 Quote Link to comment Share on other sites More sharing options...
tn206 Posted February 10, 2022 Share Posted February 10, 2022 I also would not have performed the testicular exam and would document on the form "patient refused". In the chart I would type out the longer version of the discussion. I probably would have signed off stating "based on examination performed, patient passes PE however GU exam declined by patient therefore not assessed". I find it bizarre that your colleagues think this was below standard of care.... 2 Quote Link to comment Share on other sites More sharing options...
sas5814 Posted February 10, 2022 Share Posted February 10, 2022 you are right and they are wrong...period. This is a byproduct of patient complaints being held sacred. To forcibly examine a child's genitalia against their will is a crime. The mother can no more insist on that than she can demand you punch the child in the face. As stated above I typically write "patient refused" and let someone with the football program be the bad guy. 1 3 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted February 10, 2022 Author Share Posted February 10, 2022 I should update, I completed the form and noted that the patient declined the GU exam. But, by default this means he is not cleared to play. I also charted like crazy...didn't matter. 2 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 10, 2022 Moderator Share Posted February 10, 2022 On 1/22/2022 at 7:57 PM, Ty2PA said: Hey you experienced PAs that were involved last year while the name change was being considered: do you know the AMA position on MCP? We all know practically every medical specialty has come out to condemn "associate", but I can't find information on whether AMA and specialty associations would have gotten behind something like MCP. That would be valuable to know. 1 hour ago, LKPAC said: I probably would have written "declined" on his form under genital exam and signed off anyway. Then I would have a detailed note in my chart as to why and that I explained the potential dangers to mother and patient. 1 hour ago, sas5814 said: you are right and they are wrong...period. This is a byproduct of patient complaints being held sacred. To forcibly examine a child's genitalia against their will is a crime. The mother can no more insist on that than she can demand you punch the child in the face. As stated above I typically write "patient refused" and let someone with the football program be the bad guy. Wow, simply wow. You did the right thing, unquestionably. Honestly you have do decide if you want to work with such morons and unethical people. I would do some soul searching and if you decide to fight I would file an official request for review by the medical ethics board of your facility. If they do not have one I would approach a medical school in your state and ask them the question. I truly can not see how anyone would want to force a GU exam on a child who has an opinion, has autonomy (although not total as the guardian/parent has this). If you look at custody battles over kids the courts clearly allow the child to have input in the decisions (not sure if it applies in this case but in my mind it is a valid comparison). Depending on how a professional independent medical ethics committee answers you might then take the fight to them, and the providers whom disagreed with you. Unsure how to do this, maybe you do a formal "grand rounds" that is mandatory to the other providers to educate on patient autonomy. I am honestly just amazed other providers went along with admin saying you should have done the exam against the child's will. This is one of those cases you should sleep soundly for doing the right thing and the system be damned!! May I ask what state you are in? I wand to dive into this a little more on my own.... 1 Quote Link to comment Share on other sites More sharing options...
Randito Posted February 10, 2022 Share Posted February 10, 2022 I think you should ask your colleagues, "Since all of you would have performed this exam against the will the patient, please explain in detail how you would done it. Physical or chemical restraints? Procedural sedation? What exactly is our policy?" Unbelievable! 1 1 Quote Link to comment Share on other sites More sharing options...
trazodone Posted February 10, 2022 Share Posted February 10, 2022 Couldn't support you more. Would they have stood with you if the child kicked you in the face and injured you? What about a lawsuit because you forced this child to undergo a sensitive exam. Would you have to pay for the PTSD therapy visits for the next 60 years? Horrible. I would search for a new job. Quote Link to comment Share on other sites More sharing options...
UnionizePAnow Posted February 10, 2022 Share Posted February 10, 2022 (edited) I am pretty sure MD/DO's wanted to "Show" you and other APPs who is in charge and wanted to use you to go after APP's. Other scared PAs and NPs there just went along. Losers. This is why we need OTP and our own PA board so we dont get bullied like this Edited February 10, 2022 by UnionizePAnow 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted February 10, 2022 Share Posted February 10, 2022 Your colleagues amaze me. It's been a fact that male GU are handled with a different level of care than female though, I remember seeing similar sports physical sheets requiring testicular exams, hernia checks and rectal exams, absolutely ridiculous. Most of the articles out there surround forensic exams and basic pelvics for minors, again proof that folks think poking a young man dropping trousers is somehow less potentially damaging than a female. https://www.acepnow.com/article/dos-and-donts-for-pelvic-or-genitourinary-exams-in-minors/2/ https://journalofethics.ama-assn.org/article/should-physician-comply-parents-demands-forensic-exam-16-year-old-trauma-patient/2018-01 I just spent about 30m looking for other articles and this is about it. Most everything is regarding female minors and forensic exams. Good luck. I'd reach out to ethics as mentioned above (this is worth a fight, both for yourself and any patients that come through) and look for a new position. Quote Link to comment Share on other sites More sharing options...
SedRate Posted February 10, 2022 Share Posted February 10, 2022 Wow. That is ridiculous. I'm sorry this happened to you. 1 Quote Link to comment Share on other sites More sharing options...
Ridiculopathy Posted February 11, 2022 Share Posted February 11, 2022 I'm a practicing outpatient internal/family medicine PA since 2006, who has done numerous sports physicals. You are right and your colleagues should be ashamed! Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted February 11, 2022 Administrator Share Posted February 11, 2022 I don't do sports physicals for football, period, based on the concussion risks specific to that sport, but if I did, I sure wouldn't do a testicular exam without consent. If written up in those circumstances, I would take the write-up and use it as the basis of a medical board complaint against every licensed healthcare professional who participated in such a travesty. 1 2 Quote Link to comment Share on other sites More sharing options...
Rose66 Posted February 11, 2022 Share Posted February 11, 2022 I never had this happen to me in the past, but I think I would have put on the physical form for Genital exam, ( Not performed, pt refused exam). Now on the other side of the coin, adolescents are hard patients. Make sure you engage w him/her before you do the physical, it goes much smother . I had a case where the male child did not want me to do a Genital exam , and the mother said " oh no, don't waste my time" and she throw him on the examining table and said go ahead please check him and I got to check the pt. But if there is a plain NO. Put it on the Physical form and tell the pt and the mother/father he might be rejected to play until he gets it done. Quote Link to comment Share on other sites More sharing options...
kidpresentable Posted February 11, 2022 Share Posted February 11, 2022 3 hours ago, rev ronin said: If written up in those circumstances, I would take the write-up and use it as the basis of a medical board complaint against every licensed healthcare professional who participated in such a travesty. I like this. What exactly does “formal reprimand” mean? Does it affect your reputation with patients and colleagues? Depending on how the appeal goes, I myself would be a hair’s breadth away from some legal action. Quote Link to comment Share on other sites More sharing options...
Mayamom Posted February 11, 2022 Share Posted February 11, 2022 You seriously need a new job. As stated above the patient compliant is now the priority not what best & right for the patient. Unbelievable. Quote Link to comment Share on other sites More sharing options...
UnionizePAnow Posted February 11, 2022 Share Posted February 11, 2022 Should not have MD/DO on the board. Should only be all PA's. Screw them... 1 Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted February 11, 2022 Share Posted February 11, 2022 Find a new job. Not sure I could live with that, knowing I was reprimanded for doing what’s right. I know you ortho pods go around and help underserved populations with sports physicals etc, mostly on your own time, only more salt on the wound. Quote Link to comment Share on other sites More sharing options...
Cideous Posted February 11, 2022 Share Posted February 11, 2022 1. He should not have to leave HIS job for doing the right thing. 2. I have done thousands of sport's physicals and you are exactly right. No GU exam no sign off to play. 3. Another tip. Always bring a chaperone into every singly sport's physical regardless of their sex. I don't care what the MA is doing. Have them drop it and chap you and then document who was your chap. Anything less is asking for trouble. 4. So you are telling us the medical advisory board stated that you should of honored the mother's request to forcibly hold an 11 year old boy down and physically touch his testicles???? I hope there is more to the story because that one sentence screams lawsuit/jail to me!? 5. If point 4 is true, I would reach out to a medical ethics lawyer for advice because you might have grounds for one hell of a lawsuit. 2 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 11, 2022 Share Posted February 11, 2022 (edited) In Texas it’s on the form. If it isn’t checked off then the participant isn’t cleared, period. Male only. https://www.uiltexas.org/files/athletics/forms/PrePhysFormRvsd1_10_20.pdf Edited February 11, 2022 by GetMeOuttaThisMess Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted February 11, 2022 Share Posted February 11, 2022 Shocked and appalled...... sufficient words escape me for the complete disregard for this kid. You did the best and correct thing for all involved. The forms in our state do not say disqualified if no genital exam. They are brutally simplistic forms that don't really serve as good detail of proper examination. I have marked the genital exam for years as "deferred" and never had a problem. Parents have been in the room and/or I get a chaperone. I talk about testicular self exam with the right age young men. Used to use Lance Armstrong as my testicular cancer example but that blew up in my face with doping and disgrace. Unless this kid had acute testicular torsion - there is no reason to FORCE an exam on him. Mom sounds pathologic and something is way off - does this kid even WANT to play football or sports or are parents forcing it on him. Your actions should be the example of proper ethical behavior and respect of a child. So sorry you are having to go through this and I sincerely hope you come through this - you deserve no reprimand or punitive actions. I have a friend who is an MD/JD on the state board in my state. Perhaps your state has one too - you can review your case with them. Stay strong 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted February 11, 2022 Share Posted February 11, 2022 The kid doesn't want a testicular exam, he doesn't play football, who cares. It certainly isn't the end of the world. While I don't have as strong as feelings as the Rev does, I could also care less about sports at that age. And clearly neither could this kid. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted February 12, 2022 Administrator Share Posted February 12, 2022 You know, I seem to recall that there's a specific phrase for touching someone else's genitals without consent or an exigent circumstance like a true medical emergency. Hm.... What was it? I can't seem to remember... https://journalofethics.ama-assn.org/article/should-physician-comply-parents-demands-forensic-exam-16-year-old-trauma-patient/2018-01 https://www.acepnow.com/article/dos-and-donts-for-pelvic-or-genitourinary-exams-in-minors/?singlepage=1 Oh, look, respecting consent was the norm even 20+ years ago https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828229/ Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted February 20, 2022 Author Share Posted February 20, 2022 Sorry for the lack of update...didn't have internet access for a bit while on vacation. But, I have taken some of the advice here and both contacted a nearby medical school, my state medical, PA, nursing, and ethics boards for guidance, and my state PA chapter. I may consider a lawyer as needed, but am hoping it doesn't get to that step. I guess my first step was making sure I wasn't off the wall here, so glad to read support for my decision. Cideous: I'm not aware of any more to the story other than that the parents wanted the patient to play football. Last note, as I am beyond the patient interaction my main point of concern is the "formal reprimand" and how that could potentially impact me in the future both with my current employer and potential future employers. I am looking into the hospital bylaws and so forth to review. As I have posted elsewhere I am already looking into alternative employment options, both within and outside medicine. I'm not in a rush, but that could change depending on this "formal reprimand." 1 1 Quote Link to comment Share on other sites More sharing options...
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