OCEAN CITY — A recent doctor’s visit for a local mother and her teenage daughter took what the mom felt was an inappropriate and explicit turn, raising questions about suitable communication between doctors and their young patients.
Ocean Pines resident Amanda Lanier says she decided to visit a new doctor last week in order to get her 13-year-old daughter the Meningitis vaccination because, based on her insurance, she would’ve had to pay more than $200 out of pocket at her primary care physician’s practice.
So, she went to Atlantic General Primary Care in West Ocean City and met with a female doctor.
“She was nice at first, and tried to calm my daughter down because she is not a fan at all of going to the doctor’s office,” said Lanier, “and she is even less of a fan of shots.”
Yet, Lanier says that when the conversation steered toward teen issues, things quickly went south.
“She said to my daughter, I want to talk to you about things kids are doing at your age,” said Lanier. “She went on to tell her about drugs, and then she started asking her if kids were doing dares in her school.”
Lanier’s daughter replied with a response that she knew about the cinnamon challenge, which is the viral Internet challenge where people put a spoonful of cinnamon in their mouth and try to swallow it within 60 seconds without drinking anything.
“Then the doctor said ‘yes, well there’s another dare that girls your age are doing where they put lipstick on their lips and they put their mouths on a boy’s penis and try to see how far down they can leave a lipstick mark,’” said Lanier. “I just stood there totally shocked, and when I looked at my daughter, she was both shocked and terrified. The words came out of nowhere with no warning and I couldn’t believe that we went from cinnamon and marshmallows to oral sex.”
Lanier chose not to make a scene in the office, despite her anger, and she and her daughter quickly left the office after the shot was administered.
“I was just so angry that this doctor decided to put a visual like that in my child’s head,” she said. “I am all for a responsible conversation with kids about the dangers and the realities of sex and drugs, but her words crossed a line. I mean, she’s a doctor. She should know better. The whole way home, I was just fuming.”
Lanier recounted on social media the incident a few hours later because she wanted to see if her angry feelings were justified or if others thought she might be overreacting. More than 120 comments followed expressing outrage.
“The outpouring of support was amazing, and I knew I wasn’t wrong,” said Lanier. “I didn’t know what I wanted to happen, but I knew I couldn’t just let it go, because the worst part about it is that the challenge she was so graphically talking about is nothing more than an urban legend, and there is no record that anyone has actually ever done that before. It’s just ridiculous.”
While it’s true there are so-called rainbow parties detailed as an urban legend online, several high school students said this week they have heard of these sorts of situations playing out among their peers. In fact, books have been written on the subject of whether these are real parties worthy of a moral panic or simple fabrications that have grown organically.
The next day, Lanier met with Atlantic General Hospital Vice President, Quality and Medical Staff Services Ann Bergey, who according to Lanier, was both apologetic and supportive.
“When I told her what was said, her jaw almost hit the floor. She hugged me and said that she was sorry and that they were going to make sure it didn’t happen again,” said Lanier.
In addition, Lanier also emailed AGH President and CEO Michael Franklin to alert him of the situation and to express her disdain for what the doctor said to her child in the examination room.
In a Nov. 18 email to Franklin, obtained by The Dispatch, Lanier detailed the story and harshly criticized the doctor’s language, calling it “vulgar, pornographic and disgusting.”
Lanier then posed a question to Franklin.
“Read that again and let me know if you would feel comfortable telling a child that,” the email read. “Let me know what teachable moment can come from that because frankly, I don’t see it.”
Franklin responded in an email the following day in which he apologized to Lanier and her daughter for the “direct” way the doctor spoke.
“Unfortunately, I do not have ‘answers’ for you. I cannot undo this communication with your daughter,” Franklin’s email stated. “What I can assure is that your communication of this incident to us will result that the doctor will have greater sensitivity to young patients and their parents, when engaging in education and awareness of delicate social issues.”
When questioned if there would be disciplinary action taken against the doctor, AGH Vice President of Public Relations Toni Keiser wrote in an email to The Dispatch, “Any medical staff quality review is federally protected within the peer review process and cannot be commented upon.”
Is There A Clear Policy?
However, this incident raises a larger question about hospital policies when it comes to discussing sensitive topics like drugs and sex with adolescents and teens. While there are countless written guidelines about how parents should handle interactions with their kids when it comes to broaching these subjects, there are far fewer clear guidelines published on how doctors should talk to patients about these subjects. The line between what is deemed to be appropriate and inappropriate seems to exist in a slightly gray area of medicine.
“While it is the responsibility of Atlantic General Hospital to monitor and ensure the quality and safety of care provided by physicians affiliated with Atlantic General Hospital,” the statement reads, “we do not dictate to our physicians how to practice medicine.”
Yet, Keiser attached two documents in the email, one from the American Academy of Family Physicians and another from the American Academy of Pediatrics that seemed to point to some guidelines for physicians to follow.
In a 2012 report from the American Academy of Family Physicians entitled “Adolescent Health Screening and Counseling,” it explains that primary care physicians are “well positioned to deliver important health advice to adolescents” and “should make the most of these visits.” The report detailed topics ranging from the importance of bike helmets and the dangers of tobacco use to sexually transmitted diseases and unintended pregnancies, but there were no mention of explicit sexual acts.
Furthermore, the report says physicians should “initiate discussions about sensitive subjects, provide clear advice to patients and parents” while “endorsing good behaviors and discouraging bad ones.”
Susan Stevens Martin, Director of the Department of Public Affairs at the American Academy of Pediatrics, sent The Dispatch the 2014 AAP guidelines for contraception amongst adolescents.
These guidelines point to the Center for Disease Control’s “5 P’s of sexual history talking,” which include partners, prevention of pregnancy, protection from STD’s, sexual practices and past history. The AAP guidelines read, “Counseling should draw on motivational interviewing approaches, with the focus on future goals, belief in the adolescent’s capacity to change, and the engagement of the adolescent in the process of adopting a healthy behavior.
‘Nothing’s Really Been Resolved’
While the guidelines largely cast a wide net over a complex and touchy situation, with doctors left to make the call on a case-by-case basis, the reality is that one doctor’s tactics may be seen as offensive to some parents and patients and completely spot on and appropriate by others.
Lanier praised Bergey and Medical Director Dr. Stephen Waters, who both talked her through the unfortunate situation at great length.
“They [Bergey and Waters] brought tears to my eyes with their kindness but honestly, while I’m happy they acknowledged our feelings about the situation, I’m upset that nothing’s really been resolved,” said Lanier. “I want to know what they have changed and I want to make sure that this doctor doesn’t blindside some parent and kid again with no warning with that kind of vulgarity. I want someone to tell me that she won’t be allowed to speak to teen patients this way ever again.”