Genital Exams: parent vs. patient

[HMtoPA]

I absolutely would never, ever, ever conduct any type of physical exam on an unwilling, competent patient - perhaps most especially a genital exam on a minor.  The fact that anyone is suggesting you should have done so is lunacy.

I also would not have just gun-decked the form and document a normal exam if none was conducted.

I do think perhaps you may have been a bit too rigid in the interpretation of the form, and maybe there was a more diplomatic solution available.  The easiest thing would have been to simply cross-out that portion of the exam and write "patient deferred" or something. When I worked in primary care and had a sports physical come through I regularly did this, and never had one come back rejected - it really is just a check in the box.  From a medico-legal standpoint, I'm not sure that there is much risk to skipping a testicular exam on a high school sports physical.

In any case, you certainly should not be facing any sort of disciplinary action for respecting the body autonomy of a competent patient.  WTH.

Edited November 7, 2022 by HMtoPA

[sas5814]

10 hours ago, HMtoPA said:

 "patient deferred"

Particularly with sports physicals this is what I did when the kid refused. Its not an argument. Need to do this... patient refused. I'd write it on the form and within a week or 2 the kid would be back because the school/coach wouldn't let them participate without a full exam.

Edited November 7, 2022 by sas5814

[HMtoPA]

8 hours ago, sas5814 said:

Particularly with sports physicals this is what I did when the kid refused. Its not an argument. Need to do this... patient refused. I'd write it on the form and within a week or 2 the kid would be back because the school/coach wouldn't let them participate without a full exam.

That may be, but at least you put it on the coach to be the stickler.  

In my experience with several dozens of these exams per year (when I did family med) for kids participating in multiple sports at multiple schools, I never had a kid come back needing a reexam or heard back from them otherwise. Some may have sought care from someone else and I never knew, but others were regular patients that I definitely saw again.

I don’t doubt that there are some coaches somewhere out there that might be sticklers about this, only that I haven’t encountered them. In any case, it’s not a hill I chose to die on - I felt that by being clear that I did NOT perform the exam, and that this was done at the patient’s request, then I could morally, legally, and ethically sign the form. 

In my reading, the form shown in this thread (which is more or less identical to what I’ve seen in other states) doesn’t explicitly state that a testicular exam is strictly required, or at least that it cannot be deferred by the patient.

[sas5814]

Yea that was my point. If the kid refuses... he refuses. Just document it in the appropriate spot and sign the form with the refusal noted. If the school or the coach lets them play without it ... not my business. I was in a small town in a rural area so I know what usually happened was the coach said "get it done or don't play". For the school it's a liability issue. Why require physicals if they don't mean anything?

But OP was 100% in the right. Trying to force a child to have any exam much less a genital exam? Just no. It isn't even a grey area.

[CAdamsPAC]

Rereading this thread reminds of why I hold a large number of my PA peers in distain. These are people who either bitch about how they were mistreated or stand there silently and accept maltreatment by management clinical or administrative without displaying any degree of professional courage. They don't seem to realize their acquiescence to these people's behavior paints a bigger target on all of our backs! I applaud the OP's not just defending themself but going on the offense against the perpetrators. I recall the many old SF NCOs who became PAs who were my role models in the Army who demonstrated to me that one doesn't cower in the face of being wronged!! Our profession needs to stop playing the patsy to administrators or other professions.

[cordelia*8]

That is so fucked up. I would've done exactly the same.