Mother offers to hold son for forced genital exam

[TooShy]

As I've explained in my post "The Legend of the Pecker Checker", I quit playing sports over my fear of the genital exam. Below is a post made by a physician assistant to a PA forum complaining that he was given a formal reprimand for not complying with a mother's request to force her son to submit to a genital exam. The mother even offered to assist. Considering that her son would not be allowed to play football without the exam and that would impede his potential for future football participation, scholorships, etc., what should the PA have done?

Curious how others have handled these types of situations, because I am in shock at my current employer.

I am an ortho PA, but during one of my "redeployments" to UC (a separate issue for another time) I had a mother bring her 11yo son in for a sports physical to play football. On the sports physical form a genital exam is required for contact sports for a hernia check and to ensure the presence of two testicles*. The patient in question declined the testicular exam. I counselled the patient on the requirement and that I could not sign off on his form if he didn't have the exam, and therefore he would not be able to participate in football. He decided against the exam and was fine to not play football...his mother lost it. She tried talking him into it, but he continued to decline. She then tried to get me involved, obviously wanting to force him to do the exam, offering to hold him down for me. I declined stating it was his choice and if he changed his mind he could return to complete the exam in the future. To put it simply...his mother was having none of it and this resulted in a complaint to admin. To make clear: he had no medical concern, neither did the mother. This was ONLY to participate in football.

The complaint resulted in a meeting with administration as they felt my decision was inappropriate. Following protocol I requested a provider hearing, which is a meeting with admin and subset of providers to give clinical input. To put it simply, I was astonished to hear colleagues (male and female...MD/DOs, PAs, and NPs) stating the genital exam should have been completed per the mother's request. I asked whether hymen checks should be performed at a parent's request to confirm virginity and it was a resounding NO. Furthermore, a local college's athletic form requires a female genital exam (for unknown reasons, we've tried to have them remove it but they refuse) and it is our policy to not complete the genital exam unless the patient has a medical concern. But, for some reason a testicle exam on a male against the patient's wishes without medical reason is ok? To me this would be grounds for medical battery, and possibly could even be construed as sexual assault...but I'm not a legal expert.

The result of the hearing was that I did not meet "standard of care" and therefore would have a "formal reprimand" placed into my file. I am flabbergasted to say the least!

I am in the process of appealing and looking into my options, but curious for input on whether others would have performed the testicular exam.

[TooShy]

In my case, I wouldn't have had a future career in sports anyway, but I think my parents should have pushed me to do it anyway. Ironically, only a few months after avoiding the pecker checker for a sports physical, I had an annual checkup that included a genital exam.

[jllash]

what should the PA have done?

The PA performed exactly as they should IMO. 11 is old enough to be entitled to privacy and body autonomy, especially when there's no medical issue to be addressed. I feel it's extremely inappropriate for the mother to try to force him to undergo the exam, and for the administration to formally reprimand him. It sounds like a cut and dry case of a double-standard at a systemic level.

Secondly, the need for males to be forced to have a genital exam to perform sports seems messed up as well. Let him decide if he's comfortable playing sports, there's no reason for a genital exam.

I found the thread where the post came from, and I feel some hope seeing that all the other members of that board are on his side, hopefully this process changes in the future. I have to wonder where it even comes from, who is the person at the top that made the decision that this checkbox is needed to play football? And why aren't they held responsible for requiring something that isn't needed?

EDIT: reading more from the thread, looks like the reprimand was rescinded and his colleagues faced some consequences for their judgement, or at least had to undergo ethics training, so that's a good sign. Still bothers me to see that even if a patient declined, coaches/schools will refuse to let a kid play football without the genital exam, since there's no reason for it. Surely they only care for insurance reasons, so why does insurance care? I hate how opaque these systems are, just a big wall of faceless bureaucracy determining rules where you can't hold anyone responsible because you don't know who is responsible.

[PantsDownFun]

what should the PA have done?

The PA performed exactly as they should IMO. 11 is old enough to be entitled to privacy and body autonomy, especially when there's no medical issue to be addressed.

11 seconds old is old enough to be entitled to bodily autonomy (if not privacy) when there's no medical issue to be addressed. I swear, way too many parents see their children as craft projects instead of people. I'm sure my mother would be not just offering to hold me down but already be holding me down and trying to force my pants down so that the exam could take place if her vision for me involved sports instead of music.

[RaccoonBatteryStaple]

Below is a post made by a physician assistant to a PA forum complaining that he was given a formal reprimand for not complying with a mother's request to force her son to submit to a genital exam.

She then tried to get me involved, obviously wanting to force him to do the exam, offering to hold him down for me. I declined stating it was his choice and if he changed his mind he could return to complete the exam in the future.
...
To put it simply, I was astonished to hear colleagues (male and female...MD/DOs, PAs, and NPs) stating the genital exam should have been completed per the mother's request. I asked whether hymen checks should be performed at a parent's request to confirm virginity and it was a resounding NO. Furthermore, a local college's athletic form requires a female genital exam (for unknown reasons, we've tried to have them remove it but they refuse) and it is our policy to not complete the genital exam unless the patient has a medical concern. But, for some reason a testicle exam on a male against the patient's wishes without medical reason is ok?

There's so many layers here to peel back.

Without question, the PA was not in a position to conspire with the parent to force the exam. While I'm not as shocked as I'd like to be about the decision of the board, it would have been completely unethical for the medical professional to proceed as they have no authority to compel any action and I would hope a legal team would agree.

If, rather than arguing and then trying to enlist the help of the medical professional to bully the patient, the mother had simply pulled down the son's underwear and directed the PA to complete the exam, I could see that as a little more of a grey area. Yeah, we would want the kid to have agency in the decision but now the mother has deliberately taken all the responsibility and the PA's involvement is much more passive.

Ideally even then the PA still should have had the space to decline the exam or at least bring in a senior physician to mediate the situation based on office policy. But it's also clear the office applies their internal policy inconsistently since they say they only do the checks when medically advised but clearly they do it all the time so they can complete the sports forms.

I say all this because I'm 100% confident that if I'd been given the opportunity to opt out of a genital exam at that age regardless of purpose (sports, school enrollment, insurance requirement, or even health concern) I would have taken it -- just like I would have opted out of getting a shot or even having my temperature taken if I could have said no. But I firmly believe the ability to flatly decline any of these things at that age would not have been in my best interests and I would not have been competent to make those decisions.

Obviously the mother should have set expectations prior to the visit and worked to manage the boy's insecurity so the entire situation was avoided. And there are all kinds of other questions here about whether the decision to join the sport was made by the child or the parent(s), and if the kid was unwilling to let the PA see him naked what was he going to do in the locker room before and after the game with coaches and peers around?

So to me, the real issue seems to be the mother not helping the son constructively work through his insecurities (or at the very least, that's what I needed at that age and I'm projecting). But if my parents had been through all that with me in advance and I had agreed at home only to chicken out after we got to the exam room (especially if they'd paid all the fees and bought all the gear and would be paying for the office visit) I feel like either parent would have been absolutely justified in pulling down my briefs on the spot.