Sorry, Mom, no praise for getting your 12 year old the Pill
No one likes unsolicited advice. It doesn’t matter if it’s good advice and it doesn’t matter if it’s well meant. Patients are no exception, even though part of the provider’s job is to counsel patients about their lifestyle choices. Smokers don’t want to be told not to smoke; overweight people don’t want to be told about the risks to their health.
That’s why I always tried to confine myself to the unadorned facts, and carefully excise any value judgments from my comments. Every now and then, though, I couldn’t help myself.
Any gynecologist is depressingly familiar with sexually active young teens and preteens, and the dreadful consequences. I often saw these girls in the Emergency Room in the middle of the night, unaccompanied or accompanied only by teenage friends. Certainly, no one came in with her mother. Perhaps that’s why I was not expecting a discussion of birth control when an affluent mother brought her 12 year old to the office for a consultation.
Improbably, the mother was beaming. Very few people are beaming at their gynecology appointment.
“We’re here for the Pill,” she announced cheerfully.
“The Pill,” I was shocked and it must have showed. “Who’s here for the Pill?”
The mother plowed ahead. “I brought my daughter to get the Pill. She’s sexually active.”
I turned to the daughter. She nodded her head slightly in affirmation.
“I’ve explained,” the mother continued, “that when you are sexually active, you always have to use protection, and the Pill is the best protection there is. That’s why I brought her myself.”
“Well,” I started tentatively, “the Pill is the best protection against pregnancy, but it doesn’t offer any protection against sexually transmitted diseases. Before we get to that, though, I’d like to talk a little more about sexual activity. I turned to the daughter again. “What grade are you in?”
“Seventh.”
“How old is your boyfriend and what grade is he in?”
“He’s 17 and he’s a senior in high school.”
“Yes,” the mother confirmed proudly, “she’s dating a senior.”
“Have you considered,” I ventured, “that might not be such a good thing?”
“What do you mean?” The mother was clearly annoyed.
“I mean,” I said, “that 5 years is a big age gap. There’s a big difference between a seventh grader and a high school senior.”
“So?”
“So, the needs and desires of a 17 year old boy are very different from the needs and desires of a seventh grader. A sexual relationship might seem like a good idea for a 17 year old, but it’s inevitably a bad idea for a 12 year old.”
“But she wants to date him,” the mother responded.
“Yes, she may want to date him, but that doesn’t mean that there might not be an element of coercion involved. Let’s think about this for a minute; what kind of 17 year old boy dates a 12 year old? It’s usually someone who has no success with girls his own age, and has to reach down to much younger children to have a sexual relationship.”
The mother was clearly growing angry. “But I thought you’d be impressed that I brought my daughter in for birth control,” she said, “My mother wouldn’t have done anything like this. She didn’t even tell me the facts about sex.”
“Sorry, I’m not impressed that you brought your sexually active 12 year old in for the Pill. I’m worried that someone is taking advantage of her.”
I kept looking in the direction of the daughter, but she made no response.
“We didn’t come here for your dating advice,” the mother replied heatedly. “Are you telling me that you won’t give her a prescription for the Pill?”
“No, that’s not what I’m saying. If her exam is normal, and she has no risk factors, I’m certainly going to give her a prescription. She’s sexually active and she needs to be protected from pregnancy. And I’m going to talk about condoms, too, since the Pill does not protect against sexually transmitted diseases.”
The mother was not mollified. She sat stonily through the rest of the interview and exam. When I finally wrote the prescription for birth control pills, she snatched it from my hand.
“Thank you,” she said coldly. “That’s what we came for. And by the way, the next time we want your opinion, we’ll ask for it.”
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Comments
"she knows doctors are there to make you ashamed of yourself"
Why should the girl be ashamed that her mother was so desperate for her child to be socially successful that she allowed a much older boy to sleep with her?
I doubt very much that this girl is completely comfortable herself with this relationship. I find it very hard to believe that she isn't feeling pressure to do things that she probably doesn't want to do and her mother's complicity might only serve to add subtle, unwanted pressure for her to keep herself in a situation that she might not want to be in.
Quite the contrary I would say that because of your actions perhaps somewhere along the lines this young girl is going to realize that there are people out there who think rationally and there are people out there who look out for their best interests and perhaps most importantly that there are people out there to whom they can turn in times of need.
"She seems almost impressed by this inherently wrong relationship."
That's what bothered me the most. She was proud that her daughter was "dating a senior" and oblivious to the fact that the boy's only interest in her might have been because she would have sex with him.
That was not the only time I've seen parents "impressed" with things that seem horrifying to me. I recall an acquaintance, a father, bragging that his daughter (age 12) was the first girl at sleep-away camp to be invited to "make-out" behind the dining hall.
"I agree that you handled it horrendously"
I think I handled it just fine. In fact, I think I showed a great deal of forbearance in the face of utter stupidity and selfishness. My impression was that the mother thought it was all about her: her desire that the daughter "date" someone much older; her desire to be praised by the doctor; her need to prevent the daughter from getting pregnant.
I hoped that the daughter, who said surprisingly little, heard the message that there it was wrong to sleep with a 17 year old boy, not a source of pride; that older boys sometimes use younger girls for sex and she should be wary; that she had the right to say no; that there were other harmful consequences to sex besides pregnancy; and, most importantly, that I cared enough about her to investigate.
WHY BUY THE COW WHEN THE MILK'S FREE?
Not to mention what a screw up for a parent. She can't parent, discipline (not the same as punish - see Webster's), teach, influence her own child so she gives her over to her own very underdeveloped and immature judgments (and I have no doubt she is being coerced into sex from her predator boyfriend - sure 5 years is no big deal when your 25 and 30, but 12 and 17 - the maturity level are worlds apart)? This woman needs to quit trying to be her daughter's big sister and be her MOM. One more year and dude is guilty of statutory rape which qualifies him to register as a sex offender. In some states, he can be charged with Statutory rape right now at age 17, be foreced to register as a sex offender and be banned from living in certain areas or near certain bulidings that are almost impossible to avoid like churches and schools. Often a trailer park is the only place far enough away from said buildings. How would Mr. Pish Posch, combing the middle schools for a prom date, predator feel then?
People need to wise up about the MANY dangers of promiscuity and pre-mature sexual relationships.
You did the right thing, though to someone as dim witted as that woman, I doubt it sunk in.
It is obvious you think you handled this well. I mean, you're bragging about it in OS, aren't you? :)
However, it still seems that your interpretation of the mother's words (she didn't SAY she was proud of her daughter's sexual activity, nor of the boyfriend, but you read into that) gave you the permission you needed to rip Mom a new one in front of the daughter, and that was, in my opinion, in terrible taste and smacks of you needing to vent, at someone, for the ills of teenage sexuality.
Seeing, what we all agree was probably awful parenting, you decided to step in and try to do the mother's job for her. However, you have no relationship with this girl and she has no touch-points on how to take your condemnation of her sexual experience, her boyfriend, or her mother. I can't see that it was at all helpful under those circumstances. *Perhaps* if you'd been her long-time pediatrician or family doctor, you could have had an open conversation with her. But you weren't and didn't.
Talking to mom, aside, would have been better. Kicking mom out and talking to the girl alone, permissible and allowed, would have been better. This did nothing more than allow you to kvetch at this woman, in front of her preteen.
I think sometimes in order to counter the lack of sex education that they received from their parents, some parents become too permissive. I am not a prude by any means (and that's all I'm gonna say about that! lol) but I think some parents have gone overboard , where the attitude is 'if it feels good, do it!". There are fewer boundaries laid down out of fear of being the bad guy....or worst, being the uncool parent. We are not our children's friend, pal or buddy. They depend upon us for guidance and in some arenas we fail them miserably.
I can't say that I have a problem with the child being present during that discussion. She is THE discussion, so she has every right to be there. If she thinks she's old enough to act like a grownup, let's be open and honest with her about the consequences. Personally, I do not want my doctor to just write a script and send me home. I want dialogue.....and dialogue doesn't kill, maim or injure.
I think the mother was offended because you did what (in all honesty) she should have and she felt that you tried to overrule her parental authority and you shamed her in front of her kid. I get that. No one wants to be told (however nicely) that they suck as parents (no matter how true that is). I just wish parents would remember who the grown up is in these situations and behave accordingly. /rant
So this is 12 year old girl isn't mature enough to realize she's being used by a 17 year old, but you expect her to be mature enough to realize that she doesn't need to be ashamed that her mom's a kook? And that the doctor is calling her mom a kook right in front of her?
I don't believe that this actually happened. I think this a load of bunk that you've made up to prov e some sort of point. But if it is true, you are a lousy doctor, and should lose your license immediately.
BUT, you should have realised the mother was not seeing this and looked for the best possible way to handle the situation. Instead the meeting ended with a degraded child, an angry mum and a situation likely much worse than when they arrived.
To then post this publicly and look for sympathy with your side is both unprofessional and wrong. I think you need to think very carefully about the morality of posting personal stories of patients (names undisclosed or otherwise). Especially if you can't communicate with them in a way that doesn't escalate the situation.
The reason this annoys me the most however, is the one person you should have been helping (the little girl) is the person who seems to have come out of this the worst.
On the other hand, I think it might have been helpful to talk to the young girl alone. This might not have been possible or practical, but I find that young people having sex are going to do so regardless of what their parents say. Growing up, I had friends who had very "hippie dippie" free-love parents who gave their kids condoms; some of these kids waited until college to have sex... while other kids in high school had ultra-religious, ultra-conservative parents who basically forbid any sort of sexual activity. These were sometimes the kids having all sorts of sex and, occasionally, getting pregnant.
When I was 15, I "ran away from home" for a period of around two months. During this time I met and became intimate with a woman who was 24 - she provided me a place to stay, food, sex, and companionship.
I don't think I was taken advantage of in any way, really - and I was going to be a sexually active teen regardless of what my mother wanted me to do. What allowed me to have a healthy sex life as a teenager was the fact that my parents provided me with condoms, knowledge on how to use them, and an open relationship if I needed to talk to them about anything. I didn't get a girl pregnant or acquire any STDs because there was no need to - I was given the tools to protect myself and my partners.
At what age, in your opinion, is it appropriate to put a sexually active girl on birth control if she seeks it out? And if the parents do forbid sexual activity at, say, 12 - how do they control a child who chooses to do this anyway without 24 hour surveillance?
These are honest questions, I have no preconceived notions myself and, thankfully, I have no children so I won't have to worry about this any time soon. ;) Just curious about your ideas here.
I get the sense that people are missing the health issue because it is about sex. Moreover, I think many people are projecting their feelings onto this girl. THEY would would have been embarrassed to discuss the actual reason for needing birth control at age 12, but that doesn't mean that she was. She had grown up with a mother who practically encouraged such behavior. I might have been the first person to present her with another way of looking at sex.
Instead of confirming her mother's teaching that sex was a way to become popular, I emphasized that sex was about doing what seemed comfortable to you, not what would enhance your social standing.
Dr. Amy, it must be conflicting and difficult to not report knowledge of a future crime?
"Had the mother wanted praise for allowing her child to smoke or drink alcohol, I would have responded in a similar fashion."
Wouldn't you have called CPS in that case, since giving alcohol or tobacco to a 12 year old is illegal/child endangerment?
At least, I think it would be?
As for it being about sex, it's only relevant because that "health issue" is a bit more personal and touchy for some people to discuss. What seems to be the only unfortunate thing is that we don't know WHAT the girl thought, since it seems nobody ever asked her. Maybe she loved the guy as much as a 12 year old girl can love a guy - maybe she was doing it for social status. Maybe she just really enjoyed sex. Maybe she didn't want to be with the guy at all and it really was all about the mom.
Thing is, she was never asked in a private setting so how do we know what she was thinking? I know my mom always talked a lot for me when I was younger... and I usually was thinking that she was nuts. It was just easier for me to keep quiet.
"Thing is, she was never asked in a private setting so how do we know what she was thinking?"
Of course she was asked in private setting. That's part of the job of a gynecologist. I asked her in the exam room when her mother was outside. She replied in monosyllables the way that teens and preteens often do. Yes, she wanted the Pill. Yes, she wanted to sleep with her boyfriend. No, no one was forcing her to sleep with him.
"At what age, in your opinion, is it appropriate to put a sexually active girl on birth control if she seeks it out?"
Anyone who is sexually active needs protection against pregnancy and against sexually transmitted diseases, regardless of age. There was never any question about giving her the Pill (so long as she had no medical contraindications) since she was going to have sex regardless and birth control is basic preventive healthcare.
Thank you for clarifying that. I was somehow under the impression that you never actually spoke with the girl privately.
I suppose if it was the case that the girl was going to have sex, what else could the mother do? Maybe seem a little less proud about it, perhaps - she could have framed it like, "Doctor, I'm taking my daughter to get birth control because she is sexually active. Please talk to her about the dangers - I can't stop her from doing this but I want her to be safe about it."
Seeming... proud... of your 12 year old girl being sexually active just strikes me as a little creepy, like I said. I guess I'd be proud that I had an open enough relationship with my daughter that she came to me for birth control in the first place, at least.
A lot of commenters seem to be assuming that the girl was "humiliated" by this interaction. I wonder if her reaction was, instead, confusion, the confusion children feel when they see authority figures argue about what is best for them - when, for example, parents argue in front of the child about how she should be disciplined. In this case, she is seeing her mother chastised by her doctor. I remember a couple of instances in my childhood when I saw my parents criticized, and my reaction was ashamed, for sure, but not for myself - I was confused by the idea that my parents' behavior and attitudes were not infallible.
I am ambivalent about your decision to pry into the situation in the first place - the mother's assertion that "the Pill is the best protection" was freely offered, so you had every right to challenge that, but asking details about the girl's relationship might not have been appropriate. A mother has the right to ask for birth control for her daughter no matter what her age, and for all you knew before asking, this could have been an exceedingly mature 12-year-old with an age-appropriate boyfriend, the mother could have discussed the pros and cons of sexual activity with her at length, and could have been completely opposed to her daughter's choice but still responsible enough to help her exercise it as safely as possible. I don't think we can consider a 12-year-old's answers to a doctor's questions to be freely offered information, so I think you were crossing a professional boundary there.
However, once you knew something about the circumstances, the idea that it was "not your place" to address them seems strange to me. This mother is putting her daughter's physical and mental health in jeopardy, and you are her doctor, even if it's only for the period of this appointment.
You also agreed to prescribe her birth control, as was appropriate.
It would have been preferable if you could have talked to the girl alone, but it might also be valuable for the girl to see an authority point out the serious flaws in her mother's parenting. Even if it's difficult for the girl to hear your words now, she might look back later and realize that your response to this situation has validated some of her own feelings about her mother and/or changed her perspective.
It seems like that would put you in a very difficult spot.
By the way, I define the 17 year old as a predator based on your "Statutory Rape" story posted on 3/9.
Please tell me you're not a parent -- please.
Doctors are here to do what they're trained to do: keep us healthy. They're not here to blow sunshine up our skirts or be supportive of every dumb decision we make for ourselves... or, in this case, for our children. Shame, in measured doses, is a perfectly acceptable tool for shocking the hell out of a person oblivious to the harm they're doing to themselves.
"Doctor, I'm taking my daughter to get birth control because she is sexually active. Please talk to her about the dangers - I can't stop her from doing this but I want her to be safe about it."
One would HOPE that a COMPETENT physician would know to do this without being prompted by a parent. But Amy never didn't.
@Amy:
"I think I showed a great deal of forbearance in the face of utter stupidity and selfishness. "
You accomplished nothing beyond reinforcing your own self-righteousness. You alienated the mother and possibly the daughter as well. Who was selfish here? YOU! You are more interested in being right than helping someone.
You never seem to get that when it comes to someone else's behavior, YOUR opinion (right or wrong) MEANS ABSOLUTELY NOTHING. Only THEIR opinion is important, because THEIR opinion will dictate THEIR actions. Even (especially) if their opinion is foolhardy, mean or downright stupid.
What's most shocking is this:
"I think I handled it just fine."
How disappointing.
All those bad, bad people making such bad, bad decisons about sex and their children.
Glad to see the daily report.
I just realized.
"Skeptical OB"
"SOB"
That's what it says at the top of your page.
Amy the SOB.
Wow.
Freudian?
I forgot to take the pill at 17. Tell me a 12 yo especially with a mother like that will remember. Could you have consulted with the girl privately to see if anyone else was or had been sexually abusing her? I do not think MOST girls are going to be sexually active that early unless something else was going on or had. I was one who I really don't think would have been sexually active as early as I was had I not been abused that way. I was older than 12 though.
Pregnancy doesn't kill or injure permanantly near as many children as VD right? I am surprised she didn't want her to have his child I mean he was a Senior in HS!!!!
I know women like this, unfortunately one is the mother of my niece.
I would have went all Dr. House on her (the mom's) ass.
I'm assuming that this exhange also took place in Massachusetts, where the age of consent is 16.
There's a much bigger age and experience difference when it's a 12-year-old and a 17-year-old than a 12-year-old and a 14-year-old. (Not to mention that a 17-year-old is over the age of consent while the 12-year-old is below, whereas both the 14-year-old and 12-year-old are below).
I share your disgust with the mother, but did you notify any of the child welfare authorities about this situation?
I get where the doctor was coming from here. The problem is apparent for the mother and she needed a good talking to to get her into reality and out of living vicariously through her child.
The conflict for me is for the young girl. Young girls want male attention. It is a fact of every girl I have ever known. It is the responsibility of the adults in their life to help them manage their way through their budding sexuality. This girl had no guiodance. What we want at that age and what we are ready for are often confused by hormones and a lack of maturity and self confidence.
I remember trying to leave the house once in 8th grade and hit the bottom step just as my mom and dad said you look beautiful. I quickly said thank you and they quickly said "for a 21 year old" You're not ready for the attention that will bring you. My mom went upstairs with me (clearly pissed off as I was) told me there will be a day when I could wear exactly what I had on and carry myself beautifully and manage the attention it attracted but for now we were going to "bring it down a notch". I had a choice...keep the mini skirt and put on a less skin bearing top or keep the top and put on a pair of jeans. My mom talked to me about getting in over your head and her responsibility to protect me from too much too soon. As much as I hated her for telling me I wasn't an adult yet....I later was thankful for the many loving exchanges we had talking about how sexuality is normal and I shouldn't be ashamed of my body, but there is a time and place for everything and whenever I was rushing anything I was heading for trouble. I learned how to be a strong happy well adjusted girl then woman who chose when to be sexually active not have it happen to me.
Had my parents just said "no way that is slutty" or even just "you're not going out of the house looking like that" I dont' think the outcome would have been the same. That says immediatly your dirty, sexiness is bad.
So in relation to this post...I think a private talk with mom and an educational talk with the girl about all that is involved, but with no shame attatched this would have been perfect.
Young girls already feel ashamed for having sex when they are appropriately doing it. And it is a natural part of life.
Thank you for still giving her the pill and I do see where your heart was in this.
I've had so many visits such a this one, as well as the sister visit: the virgin check. And they are all about parents thinking they are doing the right thing for their kids during the rocky period that is adolescence.
Our first priority: figure out who your patient is. In this case, the priority would have been to get more information from the 12 year old and less from the mother. Why? Because you really need to skillfully suss out what is going on in her relationship, in her life, in her family, school, etc. We conduct a full psychosocial assessment (School, Home, Education, Activities, Depression/Self-Esteem, Sexuality, Substance Use, Safety) in private and get her to a) feel comfortable with you and b) share what she really feels about this sexual relationship. There you can help her have the a-ha experience about what, if anything, she is getting from this sexual relationship:
(Oh so all you've told me is that everyone thinks it's so cool that you are dating a senior. I've not heard anything about how much you like the actual sex. You seem to like the kissing and touching, but the sex doesn't seem to add that much. And really, that's not uncommon for girls your age. It generally takes a little more body comfort and...don't shoot me for saying it...maturity for sex to be really great. You get what I'm saying?)
The key here is that getting into the kid's head is the most important thing, and if you were just getting monosyllabic answers, then you weren't very good at doing it. It also might have been that your exchange with the mom ruined any chance you had had to set the stage with her for meaningful dialogue when you did get her alone.
Again, I've had tons of parents believing they're doing the right thing by their kids as far as their sexual health is concerned. Yet we teendocs and teen gyns know that it is important to create relationships with the teens in order to help them. And that means forming alliances with the parents. Our mantra for teens is do what you need to do to get them back. Only with time can we effect behavioral change.
I think you focused too much on your ire with the parent over the actual patient: the 12 year old.
Now let me get to my conference.
"they quickly said "for a 21 year old" You're not ready for the attention that will bring you. My mom went upstairs with me (clearly pissed off as I was) told me there will be a day when I could wear exactly what I had on and carry myself beautifully and manage the attention it attracted but for now we were going to "bring it down a notch"
Bravo!
My young teen daughter knows that I will not buy her clothes that are transparent, show to much skin, etc. As I've explained to her, feminism means that women no longer have to display themselves as if we were merchandise.
"she knows doctors are there to make you ashamed of yourself"
Amy: Why should the girl be ashamed that her mother was so desperate for her child to be socially successful that she allowed a much older boy to sleep with her?"
++
You had the discussion with the mother right in front of the daughter instead of pulling her to the side for a private conversation.
It depends on the state but a child under 14 is usually in a special category. Usually in the case of a 12 year old girl, it's going to be something like anyone over 13 that has sex with her is committing a crime.
Hrm? Dr. Amy being socially tone-deaf and prioritizing the making of her point over dialogue and empathetic understanding? Say it ain't so.
http://open.salon.com/blog/mary_king/2009/03/25/teens_sex_and_love--an_os_heretic
"Seeing, what we all agree was probably awful parenting, you decided to step in and try to do the mother's job for her. However, you have no relationship with this girl and she has no touch-points on how to take your condemnation of her sexual experience, her boyfriend, or her mother. I can't see that it was at all helpful under those circumstances. *Perhaps* if you'd been her long-time pediatrician or family doctor, you could have had an open conversation with her. But you weren't and didn't."
She should have pulled the mother to the side and had a chat before she reported the situation to the police both for statutory rape, child neglect, and child endangerment. The fact that she did not and only chastised this woman makes me doubt the credibility of the story.
If a 17-year-old of either sex tried to mess with my 12-year-old of either sex, they would get a long, stern, and very scary talk about statuatory rape laws and the consequences of being labeled a sex offender for the rest of their lives.
The sad thing is that these older boys seek out these younger girls whose parents either don't care enough or who simply are afraid of setting limits. They put their children at such a disadvantage. They vastly confuse overprotection, which is harmful, with just plain protection, getting the child to adulthood in reasonable physical and mental health.
Only very creepy 17-year-olds date 12-year-olds. NONE of my male friends when I was in high school would have considered doing so.
Couldn't agree more Erica. When I was a 17 year old senior, I dated a 15 year old sophomore, and even that felt kinda weird. There is definitely something wrong with a senior dating a seventh grader.
Sex is a conditioning experience. Whether from one partner or many you become conditioned by experiences - things you like, things you don't like. If this CHILD'S conditioning begins at the tender age of 12, before she can handle her own emotions, before she can balance a check book (has any self responsibilities), before she has 1/4 of life's experiences under her belt, you can bet increased promiscuity with the safety net of mom's okey dokey plus the pill, will be one result.
With promiscuity and the "protection" of the pill, most likely, other protective measures will be thrown to the wind and thus increases this CHILD's likelihood of contracting STD's (remember a child will be making those heat of the moment decisions - someone too young to know what AIDS, gonorrhea or Herpes really are and what they really do.)
This mother is a FOOL for not sitting down with her daughter and just being straight up with her about all the many facets of sex - the good, the bad and the ugly.
My son is 15 and I started educating him about sex at the age of 8. We have regular talks about it. I also talk to him about the reality of drugs and addiction. A little bit of embarrassment won't kill you, but Aids WILL.
Allie Griffith
March 25, 2009 08:32 AM
BALONEY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Of course your approach would be much better, as it always is.
Let's not forget that we use the pill in young girls for severe cramps that don't respond to non-steroidal medications and for management of polycystic ovary syndrome.
"I read most of the comments and I saw from the ones I read that no one has acknowledged the health risks involved with birth control pills, especially prolonged use as would be the case of someone getting on them at the age of 12. They can cause this cancer, that cancer, breast cancer, ovarian cancer, uterine cancer, hormonal imbalances, weight gain and the list is literally 6 feet long!"
No, that's factually false. They don't cause cancer; if anything, they are protective against ovarian cancer.
The key point that you are forgetting is that pregnancy is life threatening. Pregnancy is and has always been a leading cause of young women, even today, even in first world countries. When it comes to risk of serious health consequences and death, pregnancy is dangerous, abortion less so, and contraception the safest.
I think the title of your post is both interesting and unnerving at the same time. I don't think anybody would expect you to praise a mother for having her 12-year-old daughter put on the pill, but the truth is that it's not really your place to pass judgment either. One of the reasons that so many people actively avoid seeking out medical care is the fact that they're worried about doctors passing judgment on their lifestyles. This is a problem with society as a whole: people are coerced by peer pressure and care more about what those around them will think than about their own health. You played into that instead of stepping up to the plate and working to change it.
I think it would be pertinent for you to at least admit that you don't know this family's entire history. It's shocking to me that you're surprised by the fact that this mother was defending her comment. If you were to hear her tell a narrative of this exact story, you may well hear her speak of a comment which was not meant to provoke the conversation that it did. Your post mentions that she "cheerfully" announced that she and her daughter were in your office for the pill. This is entirely subjective. You cannot possible know everything about her state of mind. It's possible she was being cheerful to avoid facing an embarrassing situation. It’s a defense mechanism called reaction formation, expressing the opposite of how one truly feels in order to mask a painful state of mind. By your account of the daughter's behavior, it most certainly sounds like SHE was embarrassed. It's despicable that in this situation, instead of putting a young girl at ease and opening up a dialogue about her behavior, you alienated her by passing judgment on her mother, attacking her in front of her daughter. I believe that any mother would have defended her position in this case. At the end of the day, that mother has to take her daughter home and deal with the effects of this appointment while you can go home and brag about the fact that you stood up in the face of information you could not fully comprehend. She must try to explain to her daughter why you were unable to treat them civilly. There was no reason why you could have simply given them your views without telling them you thought they were wrong. In this situation, you’re a medical doctor, not a therapist or counselor or friend.
This is a wonderfully written post, but there is no pride to be gained from this account. You have changed nobody’s mind. A child at that age will take this as a reason to keep doing exactly what she’s doing. In her mind, you will most likely forever remain the nameless, faceless doctor who attacked her mother when the two of them went in for help. It’s truly an awful missed opportunity, so I feel very sorry for you, as I’m sure on some level you do too.
You handled it better than I would've Amy. One reason I didn't pursue an MD lol I'd be smacking patients around ;)
"but the truth is that it's not really your place to pass judgment either."
You bet it's my place, because it is morally and medically indefensible for a 12 year old to be having sex with anyone, just like it is morally and medically indefensible for a 12 year old to be smoking or drinking alcohol.
What's wrong with judging people for doing something medically and morally indefensible? Don't you judge people who are racists, or do you shrug it off as their private concern? Do you judge people who are child molesters or do you shrug it off as their private concern? Why do you believe that this should be off limits for judgment?
As to whether it's medically indefensible, I have no idea what that means.
And I work extremely hard not to pass judgment on people when I don't know the entirety of their situation. I've had that happen to me, and it's just about the most awful feeling in the world.
How about if you were walking down the street and heard a man call a woman a name that to you sounds offensive? Do you whip out your portable soapbox and call that man out in public? What if they're friends? What if that's how they joke and if you'd waited five seconds more you would have heard something equally offensive come out of her mouth? Do you assume it’s an abusive relationship based on one data point? Do you condemn them both because they’re using words you just don’t like?
The reason there are anti-racism laws and anti-molestation laws is exactly so chefs and hairdressers and doctors don't become judges. People go to school to learn the fine lines and learn how to judge cases of racism or molestation or child endangerment.
"The reason there are anti-racism laws and anti-molestation laws is exactly so chefs and hairdressers and doctors don't become judges."
No, that's backward. The reason that their are anti-racism laws and anti-molestation laws is because we want to add the force of law to our judgments as well as the ability to mete out punishment.
"Refusing to judge" is a judgment. It is a judgment that a behavior does not rise to a level of moral significance. Allowing a 12 year old to sleep with a 17 year old is morally wrong. It is morally indefensible. That does not mean that I would stop people on the street to give them my opinion. It does mean, though, that as a healthcare professional who cares about the welfare of children, I can and should judge the way that parents treat their children.
I wouldn't hesitate to counsel a parent who is encouraging an obese child to eat, or a diabetic child to have candy. Why should I hesitate to counsel a mother who is encouraging her 12 year old to have sex?
"You bet it's my place, because it is morally and medically indefensible for a 12 year old to be having sex with anyone, just like it is morally and medically indefensible for a 12 year old to be smoking or drinking alcohol."
To judge? No, it is not, Amy.
A Dr reviews the situation, gives treatment options that are appropriate, gives relevent info and allows the patient to make the final choice regarding treatment.
It is not your place to throw your personal "verdict" into the situation. No one is saying you can't feel a certain way, feel what you feel . . but its not for you to say who is "good, bad, morally corrupt, etc"
Odd how you think its "medically indefensiable" for a 12yr old to have sex, yet you would be the first person to say that same 12 yr old should be able to have an abortion.
Sorry kiddo, can't have it both ways.
I never said I was refusing to judge, I said I would hold off until I had the whole story. In fact, that's probably why trials work the way they do.
Also, repeating the fact that YOUR OPINION IS THAT IT'S morally indefensible really doesn't make it any truer. It just takes up time when you could be trying to make your case, because at this point you really haven't at all. And it makes it look like you have nothing new to say. Do you really not have any more to add to your point other than two words?
In the end, I find repetition to be counterproductive, so I'm stopping here. Just thought I'd mention that it's CheekyGEEK, not Girl.
Nice chatting with you :)
Adding my two cents, while I share your outrage, I have to agree with many of the comments. Your "bed side" manner did not help the situation. Perhaps speaking to the mother in private first would have been a better option.
Of course saying that is very easy, not being presented with the situation. It would have been the better option, in my opinion.
I have known MANY Moms of all sorts of different ilk and not a one would have proudly marched into an OB/GYN office and share with a professional that their underage daughter was having sex with an of age boy. Not a one would have bragged with pride either. This really missed the mark. Sorry...
"As a Dr you are required by law to report child abuse and a 12yr old girl sleeping with a 17 yr old, certainly isn't legal and may even fall under the banner of molestation."
I am NOT required to report underage sexual activity. Think about it; if doctors had to report every underage girl who was sexually active, they'd have no time for anything else. Moreover, no teenage girl would ever show up for birth control, STD treatment, or prenatal care if the result was that she was reported to the state.
Underage sexual activity is not child abuse, and I'm not sure why you are confused on this point.
I'm surprised that there aren't protocols for dealing with this kind of situation so physicians placed into a situation of having to confront a parent who is encouraging self-destructive behavior in their child—whether that be inappropriate sexual activity or a something like poor diet in a diabetic child—can maximize the chances of impacting the parent's behavior positively.
Meanwhile its' a dangerous delusion that "any sex, any age, anytime" is ok and beyond reproach. It's not shaming or anti-sex to give realistic, appropriate advice as Amy did. Parents (and yes even doctors) are so afraid to be labeled "judgmental" that we have been neglecting to give any guidance at all - and are failing in our responsibilities toward our young people. It's possible to do that without being a jerk - we can still be kind and respectful while being very clear!
Kudos for telling this girl that she doesn't have to 'give it up' to some lech, that she is worth waiting for, and that someone is looking out for her safety and wellbeing.
Maybe the girl didn't respond to it that day but believe me she heard you, and that message will stay with her.
Anything else, in my opinion, put this girl behind the self confidence eight ball more than it helped. No 12 year old likes to be lectured to
The age of consent in MA is 16 and there is no age gap exception. so, in this case it WOULD amount to statutory rape, which you would be required to report, no?
"which you would be required to report, no?"
No.
No.
-- I don't know what state you practice in but in my home state Lady Miko is entirely correct. 17 and 12 is CHILD ABUSE and you, as a professional, would be REQUIRED to report it lest you be culpable as well.
I'll concede on that point. I highly doubt that your blog description of the event is representative of what actually happened, so your remark that some "literally have no idea what happened" shows remarkable insight.
Precisely! Not reporting suspected abuse can lead to the suspension or revocation of a license to practice medicine.
In all good fun, this made me chuckle. Don't forget that pregnancy is also the leading cause of young men.
"Statutory rape is a felony"
So is cocaine use, but physicians aren't required to report that either. Physicians are under no obligations to report any crimes. They are only required to report child abuse and neglect.
EXCEPTIONS TO THE PATIENT/PHYSICIAN PRIVILEGE
"Physicians are also required to report gunshot wounds, rapes, stabbings and other crimes against patients and to provide information that they believe will be helpful in solving the crime."
This mother could be just a nincompoop mother believing she is doing the right thing to help her daughter "be popular", like Lindsay and Alli Lohan's mother.
Or the mother could be literally pimping the daughter out to make the rent.
Really, there is no end to the possibilties. I hope that if this girl returns to you Dr. Amy, you will let her know about Gardisil. It would be a shame to see this girl being treated for cervical cancer at 17, before she even has a chance to start having babies of her own.
A lot must of changed since I last used them 17 years ago - I remember looking at the insert - holding one end and letting it unfold itself all the way down to my feet in tiny red text front and back of all the risks involved. When I saw cancer all over it, I decided on an IUD instead. But again that was 16 or more years ago.
Sorry for misrepresentin' ;-)
Under Massachusetts state law, anyone who has a suspicion that a child is at risk for criminal sexual abuse resulting in physical or emotional injury automatically becomes a "mandatory reporter". A mandatory reporter is required under Massachusetts state law to make a written or oral report to the appropriate agency (they are listed under the state statutes) regarding the situation.
As a parent of a sexually active 12 yr old I'd have been doing what I could to A) protect her by making her stop having sex then B) knowing that you can't watch kids 24 hours a day I would WATCH her take the pill every single day until I thought we had Trust back in our lives again.
To everyone here talking about how Amy should have gone easy on this mum... 12 is NOT an ok age to be having sex. You're just not emotionally ready for it. It's uncondonable. It's just simply far too young.
To everyone saying "It's just 5 years - why, in 30 years time they'll be basically the same age." That's nonsense. She's 12. She's a CHILD. He's 17. A couple of decades ago he was old enough to die in war. He's a young man. Two different things. HE should never be having sex with HER. Not until she's old enough. Period.
We don't need to go into religious reasons (I'm not religious) or 'true-love-waits' (I had pre-marital sex [with the woman I married] and I loved it) or even talk about pregnancy or even STDs.
All we need to talk about here is that a 12 year is, perhaps, old enough to:
*start to recognise the faces of boys
*maybe have her own private bodily explorations
*maybe find out what kissing is like
*maybe stop dressing like a fairy princess 8 yr old
Things she's NOT old enough to do:
*Say 'yes' to sexual penetration. Certainly not on a regular basis. Certainly not with someone half as old again - on the OTHER side of puberty.
*Understand the implications of letting a man put his penis inside her and thrust it about. She's not old enough to understand the feelings. She's not old enough to understand HIS feelings.
*Accept the burden of entering into a sexual partnership. There's a lot of give and take, and a 17 year old boy takes more than a 12 yr old girl can give.
----
So. Taking it as read that it's just not ok for this 12 yr old to be having sex with this guy in the first place...
Amy, you could have handled that better. I completely agree that it's your right - your OBLIGATION - to apply your judgement when providing your medical help. The lady certainly DID come to you for an opinion - otherwise she should have just gone to the medicine ATM and withdrew her prescription from the machine - oh, wait, those don't exist because our entire medical system is based upon the sound judgement and medical expertise of human doctors.
I think there's a line - doctors should be expected to have some judgement, but also be expected to sometimes do things they don't agree with. For instance, a homophobic doctor might personally believe a gay man suffering from an STD _deserves_ to die a painful death, but the rest of us expect him to provide medical aid. Or, not that long ago, a racist doctor might have not cared whether or not a black man was experiencing such and such a sympton, who cares about another complaining black man?? whereas these days we'd be expecting him to swallow his judgement and address the symptom.
On the other hand - the worlds of abortion and euthanasia are rife with judgemental doctors, and I think rightly so. As a pro-lifer, I personally think that it's completely acceptable that Catholic hospitals not be forced to provide abortions as a service (as new Australian legislation is threatening), but I'm glad that others do think it's the right service. And, like it or not, euthanasia happens all the time and it's only through the judgement of deeply introspective and self-aware doctors that we've made this step forward in our society.
"First, do no harm."
There's a REASON that statement is so vague and open ended. The explicit implication (explication??) is that the very first thing doctors should keep in mind is that the world trusts - expects - them to use their own brain to define "no harm" in any case.
"Morals are not black and white, and personally, absolutely honestly, I don't understand what's so immoral about sex.
And I work extremely hard not to pass judgment on people when I don't know the entirety of their situation."
*****
Woman walks into a bar. She's wearing the equivalent of a bra and a extra short skirt and hooker boots. There is a rock band playing on stage for the crowd assembled within the bar. Woman thinks singer is hot and proceeds to make her way onto the stage and hump his leg and lick his chest. She's a slut. No one needs to know what her background is to make that simple observation. Her brand of "sex" in this story is immoral because .... They are strangers, but more importantly - it's a public display of sexual horniness. Not to mention the singer dude may be disgusted by this molestation.
No one needs to be a rocket scientist to ascertain that a 12 year old should not be sexually active, for a multitude of reasons and one of 'em being it's illegal. Age of consent is 16. I know several other people also made the same comment but just reiterating. It is, in fact, immoral for a 12 year old and a 17 year old to be having sex with each other.
It is very possible that this is the first and maybe only time that girl has heard from an adult that sex at her age is wrong. Maybe she will think it over. Maybe she will decide to wait.
Amy, I am curious if you mentioned the legality of the situation to the mom?
While your intentions were noble, I must say you went about this completely wrong. I was 16 when I first went on the pill and was embarrassed while speaking to the doctor (I was still embarrassed having to buy tampons) - so I can't imagine how the 12 year old girl felt. No wonder she only gave you monosyllabic answers.
JenniferC has written the only really useful comment.
I think your biggest mistake was not steering the conversation into a direction that let you continue to help - something like:
"Look, I have to say that I'm very uncomfortable with the idea of a girl so young being sexually active, but I concede that if she's going to do it she should at least be using an oral contraceptive. I INSIST that we educate her properly on using appropriate STD prevention. Having said all that I really do feel that we need to reschedule an appointment with you in another 8 weeks to see how it's going, to check that the pill is being effective, and to monitor her general health. You have to admit this is a very young age for your daughter to be transitioning into the sexual awakening of her life, so I want to monitor her and assist her making this as smooth as possible."
If anything I reckon that might scare the 12 yr old into abstinence: underage sex is supposed to be something you 'get away with' - you're not supposed to meet daily with your parents so they can watch you take the pill - count that the number of condoms left in her little bag matches up with the number of times she says she did it... ("Now, honey, did you remember to use a new condom for every time you had sex? There's a good girl.") AND bi-monthly visits to the gyno...
...that's not sexy.
I'm sorry, but if you're old enough to have sex, then you're old enough to look a Doctor in the eye and say "I have sex because I like it, give me the damn prescription."
If you're not then you're not.
That's one of the acid tests of "consent".
The mother could easily be charged with child abuse and neglect, for allowing her daughter to be victimized by sexual misconduct and potentially for obtaining means to assist the 17 year boy in gaining greater sexual access to her child.
Amazing. All along I've been thinking that child abuse and neglect were crimes. Thanks for clearing that up, Amy. I also agree with someone who commented earlier on - this doesn't ring true. Like a lot of your posts.
"I'm sorry, but if you're old enough to have sex, then you're old enough to look a Doctor in the eye and say "I have sex because I like it, give me the damn prescription."
If you're not then you're not.
That's one of the acid tests of "consent"."
It's not an "acid test of consent" and I don't know where you're getting that from. I'm guessing you're male because clearly you don't understand the body shyness that young girls have. I see that you conveniently ignored when I said I was still shy about buying tampons at that age - should I not be allowed to get tampons because of that? Teenagers are going to have sex, regardless of what any adult says and that's a reality that has to be dealt with. Doctors like Amy make girls not want to see a doctor, which is the opposite of what we need.
Hate to break it to you, but he still is.
But I agree with your handling of this. Both of them needed to hear the truth, the young child because her mother was not protecting her; the mother because she was needing to show off what a good mother she was compared to her own, who would never have even spoken to her about sex at 12. The rationale of all three parties here need to be examined and dealt with from a perspective rooted in reality. Sounds like not one of them were in that place.
I wonder (and forgive me for asking if you have said this in a comment that I missed) did you hand them some condoms as well as a prescription?
I say this as the mom of a (now adult) daughter who was sexually active at 14. I was horrified that she was active at such an early age, as well as saddened at the loss of what I perceived should have been carefree teenage days. I was angry that I had to worry about her getting pregnant, or an STD. Even more so that the young man in question was also 17 yrs. old, but in our area, she was in the "age of consent". I took her to the doctor, who very kindy and gently proceeded to lecture her about the risks to her body and psyche, while agreeing to prescribe the pill and educate her about STD's. She was furious, and like a typical adolescent reacted angrily. But I was grateful to the doctor, who took the time to talk to her, even though my daughter perceived it as intrusive and I am forever grateful for the support he provided me with. Good going.
I've read several of your posts, and just wow.
I'm so glad my doctors have always been nice, polite, and professional. You could learn something from them. Do you ever stop and think that alienating people isn't in their or your best interests?
"I wonder (and forgive me for asking if you have said this in a comment that I missed) did you hand them some condoms as well as a prescription?"
I counseled her about using condoms and about various STDs and modes of transmission. Her mother had thought that the only problem was unwanted pregnancy, but STDs can cause a lot of harm.
That aside though, one of the overlooked values of this post is that it serves as a good reminder to parents that not every parent shares the same values. I have a daughter and can say that I absolutely would not want her spending the night or traveling with a mother that was comfortable with 17 year old boys sleeping with 12 year old girls. I also would not be comfortable with parents that allow their children to have drinking parties at their home with the notion that “kids will do it anyway.” I don’t buy that at all and I’m strong enough to say no to my child when it is in her best interest.
OS members are intelligent. We don't need a fake or embellished story to understand the point you're trying to make. If you feel you must persist, consider adding "fiction" to your tags.
*****************************************
I'm a mandated reporter, too. Your posted statements and comments agree, yet you say you didn't report this incident, which means that you have committed a misdemeanor.
From the guidelines for mandated reporters:
"Partner is younger than 14 years old, but there is disparity in chronological or maturational age or indications of intimidation, coercion or bribery or other indications of an exploitive relationship."
From your post:
“Yes, she may want to date him, but that doesn’t mean that there might not be an element of coercion involved."
"That's what bothered me the most. She was...oblivious to the fact that the boy's only interest in her might have been because she would have sex with him."
"...My impression was that the mother thought it was all about her: her desire that the daughter "date" someone much older..."
"...I’m worried that someone is taking advantage of her.”
Your statements indicate you clearly thought that this was an exploitive relationship; your non-action would constitute a crime.
*******************************************************
It isn't your place to judge your patients. Yet you not only judged the patient, you also judged her mother and you did it to each in front of the other.
From your statements:
"I hoped that the daughter, who said surprisingly little, heard the message that there it was wrong to sleep with a 17 year old boy..."
"...what kind of 17 year old boy dates a 12 year old? It’s usually someone who has no success with girls his own age, and has to reach down to much younger children to have a sexual relationship.”
"You bet it's my place, because it is morally and medically indefensible for a 12 year old to be having sex with anyone...What's wrong with judging people for doing something medically and morally indefensible? Don't you judge people who are racists, or do you shrug it off as their private concern? Do you judge people who are child molesters or do you shrug it off as their private concern? Why do you believe that this should be off limits for judgment?"
It's off limits for judgement because you claim to be a medical doctor, and doctors deal in medicine, not morals. They were there for medical advice, not your moral opinion. Particularly with adolescents--who often hear something different from what you're actually saying (a phenomenon also frequently noted by wives upon presenting their spouses with the "HoneyDo" list)--morals judgements can be dangerous. You say "sex with a 17 y/o is wrong" and they hear, "sex...is wrong".
*********************************************************
You attempt to defend yourself with comments referring to portions of the described incident that either did not happen, or were not posted:
"...I emphasized that sex was about doing what seemed comfortable to you, not what would enhance your social standing."
No, you didn't. At least, not in any portion of your post. The only thing you did was--likely--lower her self esteem. You were "shocked" that the girl was there for the Pill at all, you implied that the boyfriend was only dating her for sex, which may have caused the girl to feel as though she didn't have any worthy characteristics that would attract the opposite sex, you indicated that there was something wrong with her mother for bringing her in to get the Pill, and therefore, something wrong with her for having sex and wanting the Pill.
**********************************************************
"I'm a little surprised that so many people are getting sidetracked by the fact that this is about sex. I viewed it then, and I view it now, primarily as a health problem..."
No, you didn't and don't. From your statements:
"I hoped that the daughter, who said surprisingly little, heard the message that there it was wrong to sleep with a 17 year old boy, not a source of pride..."
"...it is morally and medically indefensible for a 12 year old to be having sex with anyone... What's wrong with judging people for doing something medically and morally indefensible? Don't you judge people who are racists, or do you shrug it off as their private concern? Do you judge people who are child molesters or do you shrug it off as their private concern? Why do you believe that this should be off limits for judgment?"
“The Pill,” I was shocked and it must have showed. “Who’s here for the Pill?”
“Sorry, I’m not impressed that you brought your sexually active 12 year old in for the Pill..."
**********************************************************
I could go on, but I'm just disgusted. I don't think it's appropriate for a 12 y/o to have sex at all, but unfortunately, it happens. The healthcare provider with sexually active adolescents needs to be gentle and nonjudgemental, and should privately present facts and options free from bias. It is far too easy to damage the self esteem of a teen, or to give them permanent psychological issues, even if you have the best of intentions. The provider should privately speak with the parent (if available) to present the same facts and options gently without judgement or bias, and should present the parent with ways to develop, initiate and maintain an ongoing discussion about sex with their child, whether or not the parent approves of their child's sexual activity. The parent should not be subjected to shaming (and shameful) moral judgements that could cause them to become too embarrassed to seek medical attention for their child, or anything that would potentially damage the parent/child relationship.
If you feel that a particular sexual relationship is truly dangerous, it is your legal responsibility as a mandated reporter to report.
You, as a person, are entitled to your moral opinion. You, as a medical doctor, are entitled to your medical opinion. Limit your office comments to medical opinion, and leave the moral judgement at home--or better yet, to God, as it belongs to Him anyway.
Your analysis is filled with claims that are untrue, and basically trots out your personal opinion as if it represents some sort of standard that the rest of us are supposed to accept.
"The healthcare provider with sexually active adolescents needs to be gentle and nonjudgemental, and should privately present facts and options free from bias."
Says who? You? Where is the evidence that this is what benefits sexually active preteens?
Moreover, mandated reporting is the exact OPPOSITE of being unbiased. It doesn't merely reflect the judgment that preteen sexuality is wrong; it represents the judgment that preteen sexuality should invoke the police and the courts to discipline everyone involved.
You can't have it both ways. It happens that statutory rape (unlike rape) is not a mandated reportable event. But you think it should be. How could that possibly be compatible with the "gentle," "nonjudgmental," "private" communication that you claim is necessary? Obviously, it isn't compatible.
It's so ironic that you posted that, Amy, because that's exactly what you seem to do. I'll give you points for provoking discussion, but must also subtract them for lack of credibility.
Which of my statements of fact do you believe to be false?
I think you may be confusing my personal opinions with the facts in my comment. I don't expect anyone to adhere to my personal standards. I do expect licensed medical doctors to adhere to professional standards, and to act appropriately when treating patients.
"Moreover, mandated reporting is the exact OPPOSITE of being unbiased..."
I think you are well aware that when I spoke of being unbiased I was referring to the manner in which a healthcare provider should present facts and options. Mandated reporting shouldn't happen during the interview, so it should not affect your ability as a medical doctor to present the patient and her parent with facts and options in an unbiased way. You are not required to advise the parent or the patient that you are reporting the situation.
"...[Mandated reporting] doesn't merely reflect the judgment that preteen sexuality is wrong..."
This is incorrect. Mandated reporting is not about judging the morality of preteen sexuality; with regard to that particular topic, it's about protecting children from abusive or exploitative relationships. In my previous post, I quoted reporting guidelines applicable to the situation you stated, and I quoted the statements you made that clearly indicate that this situation was reportable.
Furthermore, you are incorrect when you stated, "[mandated reporting] represents the judgment that preteen sexuality should invoke the police and the courts to discipline everyone involved."
The only issue you are allowed to consider as a mandated reporter is whether or not the situation is reportable according to published guidelines. As a mandated reporter, you are not allowed to consider whether the situation requires police and court involvement, nor are you allowed to consider the consequences of a report when deciding whether or not you will report. That's not your call. The case will be assigned to social workers, who will investigate. They get to judge what is necessary, not you. You simply make the report if it is warranted, based on the reporting guidelines. The system isn't perfect, but it's what we have to work with. And "mandated" means that you must make the report if the situation qualifies. As I said before, failure to do so constitutes a misdemeanor. I'm wondering when you last had the training; it looks as though you need an update.
"The healthcare provider with sexually active adolescents needs to be gentle and nonjudgemental, and should privately present facts and options free from bias."
"Says who? You? Where is the evidence that this is what benefits sexually active preteens?"
For a moment, I could not believe that this statement was actually posted--then I remembered where I was. The American College of Obstetricians and Gynecologists. Planned Parenthood. Virtually every reputable organization that deals with adolescent sexual health from the perspective of a healthcare provider supplies recommendations for developing an age-appropriate treatment relationship with adolescent patients.
Do you honestly think that presenting biased personal opinions to the patient rather than unbiased professional opinions is appropriate behavior for a medical professional? Maybe at a cocktail party...
It's casually referred to as "bedside manner". Apparently, these courses were before your time in med school, but they shouldn't be necessary anyway. Treating people well and using age-appropriate interview techniques is just common--or uncommon--sense. If you don't know how and can't learn, you shouldn't be a doctor.
Speaking of (un)common sense, did it not occur to you that perhaps the daughter in your story would be more forthcoming had you spoken to her without her mother--who, according to you was very proud of her daughter's relationship--present? If you were uncomfortable with the daughter's relationship, a private interview would likely have provided you with more information.
"You can't have it both ways. It happens that statutory rape (unlike rape) is not a mandated reportable event. But you think it should be..."
I did not state that statutory rape should be a reportable offense; please do not attempt to put words in my mouth.
This situation qualifies as statutory rape in every state (with the possible exception of Alabama, where the minimum age of consent is 12) and statutory rape itself is reportable in many states (and many more when the victim is 12) but that's not what we're discussing here.
What we're discussing is whether the situation should have been reported according to the mandated reporting guidelines, which state:
""Partner is younger than 14 years old, but there is disparity in chronological or maturational age or indications of intimidation, coercion or bribery or other indications of an exploitive relationship."
Your statements indicated that the situation you described does meet the above criteria, and therefore should have been reported. The fact that the parent not only knew about the illegal relationship, but encouraged it also meets the criteria for reporting as allowing the relationship constitutes child abuse (in most states).
It's worth noting that if you were practicing in Massachusetts at the time (as indicated by various posters on your blog), you may also have been required by law to complete and submit a Provider Sex Crime Report.
The above statements are not my personal opinions; they are facts. Both reporting guidelines and statutory rape laws differ from state to state, but this situation meets the reporting criteria for virtually every state.
"How could that possibly be compatible with the "gentle," "nonjudgmental," "private" communication that you claim is necessary? Obviously, it isn't compatible."
As I stated at the beginning of this post, you are not required to inform the patient nor the parent of the report. If a report is required, it should be made following the appointment (unless the abuse is happening at the time the patient is in your office, in which case one would immediately contact security or the police). The manner in which you as a medical professional present facts and options to the patient should not be affected.
I have mixed feelings on the subject of statutory rape; current laws automatically label the younger partner as the victim when that may not be the case. I feel that the laws regarding statutory rape should be changed to allow for certain common circumstances.
My personal opinion of the current child abuse reporting system is that it needs work. Most states don't have laws that clearly define actions that constitute abuse or neglect (with the exception of statutory rape). This can make it difficult for the well-meaning Child Protective Service (CPS) workers to do their job, and easy for malicious CPS workers to abuse the system and those tangled in it. The educational requirements for a CPS worker should include a degree or substantial study in some field of human services (at the least), and more training is needed.
The system isn't perfect by any standards, but it's the best we've got for now, and it's also the law. Those reporters who choose not to follow their mandate face criminal consequences--and that includes doctors.
There's a real quick way to test that...look at when she posted this. It was March 25, the day BEFORE the Private Practice aired, so, no I doubt she pulled it from there.
I would definitely have serious concerns in this situation, and I don't even think that a hotline would have been out of place here. 12 years old is too young to be having sex (safe or otherwise) with a high school senior. Her mother is clearly endorsing and encouraging this behavior, which borders, IMO on sexual abuse/exploitation. It is clearly not this girl's free choice even if she were old enough to make such a choice.
Without any sort of long term commitment and besides that: are we not to even consider the health ramifications of putting 12 year old who have not completed development on Estrogen pills? Despite what many doctors will tell you, the pill does not and cannot 'regulate' a dang thing about your cycle. It can only eliminate your cycle and replace it with a pseudocycle: withdrawl bleeding. The inventors of the pill only included the 'placebo week' to increase acceptance. There are now birth control pills that are approved to be taken without a placebo week and women have been using the pill like this 'off label' for years.
All a birth control pill can do is eliminate your menstrual cycle and replace it with a pseudoperiod, not regulate it.
I have to agree with Dr. A here. Are we to take 'don't judge' so far that we are to allow our much younger sisters to be exploited sexually???