When a doctor is careless with words, a well-child visit can cause real pain. A well-child (or a well-teenager) visit is about looking holistically at the young person and drawing thoughtful conclusions that support health and wellbeing. The exam is supposed to build relationships and foster trust in the health-care system, both of which promote preventative care. As a former health-care administrator, I believe in this strategy. But I've seen what happens when the care delivered causes harm.
Consider this: A friend's teenager went to see a new pediatrician for a routine exam. This 15-year-old is really a young man, both in mind and body. He looks mature, and thanks to his athleticism, his body is solid. Not surprisingly, at 15 his proportions reflect the changes of adolescence. To see him, you'd know that he's fit, healthy and, yes, still growing. To see him, anyone with common sense would rejoice in a health young man moving toward adulthood. But, in this case, common sense was absent and the doctor functioned as a technician without judgment, empathy or compassion.
Fitness is measured in many ways, and doctors use several tools for assessment. One of the simplest and common strategies is the body mass index, a matrix of weight and height that determines body mass. For many people, the BMI works quite well. But for a few special populations, the results are misleading.
This teen falls into a specialized group. Taken in isolation, his BMI places him right in there with a broad range of professional athletes, all of whom would be labeled "overweight." The problem is, the doctor didn't consider that the BMI might mean something somewhat different for this young man than for most (typically gangly) teenage boys. This young man has the highly-developed muscles of a disciplined athlete. To his credit, he used his highly-developed verbal skills to explain his years of athletic training, but rather than look and listen, doctor passed judgment.
Then, just to add injury to insult, the doctor evoked shame and fear, threatening the young man with a future of poor health outcomes. Not only did he misjudge the young man's fitness, but he condemned him with an inappropriate and terrifying prognosis. The doctor made a even more fundamental mistake: He paid more attention to a matrix than to a thinking and feeling, living and breathing, young man who voluntarily submitted to an exam "for his own good." So much for building relationships, fostering trust and promoting preventative care.
Then and there, the mother was so incensed and felt so betrayed that she simply focused on getting her son out of the office as rapidly as possible. She chose to protect her son rather than confront the doctor, judging by the insensitivity of his actions that he "wouldn't hear" her perspective. She also swore never, ever, to visit that doctor again. And then she stewed with her anger and frustration, and told me all about it.
The teenager was justifiably livid and also deeply hurt. Who among us wouldn't have felt self-conscious, insecure and afraid after receiving such a lecture from a health-care provider? How much worse for a teenager, developmentally prone to heightened sensitivity both about his appearance and the injustice of adults' poor behaviors?
In listening to this story, my blood boils for the parent who expects professionalism from a physician, not a cursory exam that relies more on numbers than flesh and bones. My heart breaks, too, as I imagine a courageous young man hold himself with greater dignity than a credentialed physician.
I realize that at this well-child visit, the so-called "child" was healthier in body and mind than the doctor. I hope it never happens again, but I fear that others will have similar experiences. I'm sharing this story so any parent of a solidly-built child/teenager can be better prepared should a health-care provider miss the obvious, and make a mistake that hurts the patient and costs the health-care system dearly.
In this case, I'm writing in the hope that that you and I will intervene should a doctor wield words as weapons. To begin, we can tell the child/teenager that we don't accept the doctor's word as gospel nor condone the poor delivery. Then, we can speak civilly, articulately and confidently to the doctor.
Its not the patient's (or his/her parents') job to teach a doctor how to speak more thoughtfully. But we can speak up when doctors betray our trust with their lack of professionalism. And we should seek out physicians who model healthy behaviors and promote wellbeing with competence and caring.
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