Messaging Matters

BY MATTHEW MERITT

​To encourage teenagers to seek medical care when needed, some pediatricians now ask parents to leave the room during at least part of a checkup to speak privately with the child.
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I found this a little surprising when it happened to me at a local provider as we were preparing for the upcoming school year. Though I wasn’t worried about how my child would respond, I wondered what questions would be asked.

​This practice has been recommended as early as 2012 by the American Academy of Pediatrics  and seems to be used by both major healthcare provider in the Chemung Valley. Eleven years old is the starting point implied by the AAP. 
 
The AAP says topics include diet, sexual behavior and substance abuse.
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“Your teen may feel more comfortable talking about some of these topics with a non-parental figure,” one of its Web page says. “In addition, teens are less likely to speak openly and honestly with their doctor if they are unsure as to whether their privacy will be protected.”

Here’s topics my teen said he were raised at his provider recently:

• Depression
• Urges to hurt himself
• If he’s active sexually
• If he’s attracted to girls, which I presume to be a sexual orientation question
• If he has had the COVID vaccine

 
It’s reasonable that children need gradually to learn to do a variety of things themselves, including talk to a physician. But keeping a parent in the dark about destructive behavior can be very dangerous, particularly if doctors and parents aren’t aligned on how destructive a particular behavior is. If that happens, the doctor risks becoming a wedge in what should be a loving and trusting parent-child relationship.
 
For instance, if a child is experiencing depression, a parent may be grateful to know this in order to examine the atmosphere and influences around the home and alter them. Mothers or fathers may even need to modify their own behaviors. If a teen is sexually active, a doctor could conceivably recommend birth control but a parent might realize the child needs more attention and a more wholesome environment. 
 
Is it odd if a parent considers sexual activity in the teen years and outside of marriage as indication something is not right? What if a family takes chastity seriously? Just because the popular culture accepts something doesn’t mean all families do. Popular culture at the moment is a cesspool, so there may be some parents who would prefer other standards and messaging. 
 
In short, the solution a pediatrician may privately propose may not be in line with the way loving parents are attempting to raise their children. Messaging matters.
 
The vast majority of parents do the best they can for their children under a great deal of pressure. Most of the culture is indifferent and parts are downright hostile. 
 
Unfortunately, the AAP has attached itself to that hostility. In a 2018 Policy Statement it adopts the LGBTQ vocabulary on so-called "transgenderism" and argues that even very young children who think they are the opposite sex should be affirmed in a variety of ways. 
 
The AAP goes on vaguely to suggest legal action when parents don’t accept their children’s wishes. This is despite studies showing the vast majority of children who think they are confused about their sex embrace their biological sex firmly as adults. Further, just this year the AAP denied participation in their national conference to a group of doctors who question current transgender dogma. 
 
Responsible parents don’t need care for their children based on guidance like this. Instead they need partners. It’s a role doctors can fulfill, but with a little more common sense than what the AAP suggests. At the very least pediatricians should acknowledge and respect the way particular parents raise their children. 
 
I was perplexed that my son was asked about the COVID vaccine, though the doctor did bring it up when I returned to the exam room. Does this indicate a healthcare provider can offer the vaccine to children without parental consent?
 
I pursued the “private talk” practice with media people at our two area providers, receiving answers that were not terribly specific. I decided not to go further because we are generally happy with the care our children receive and do not want to create tension for future visits. 
 
I also contacted the American Academy of Pediatrics about their recommendation. I was particularly interested if they suggest parents are obliged to leave the exam room or have a right to decline. But they said I should talk to my children’s pediatrician.
 
Whatever the answer to that question might be, it seems something is missing in the way things are done. It must be accepted that parents are their children’s number one and most appropriate care givers. Before doctors speak with children privately, they must agree to offer advice in line with parental priorities.
 
After all, who is working for whom?