Sex, drugs and rock and roll

[Stitch]

I'm mainly curious how other programs do things. Around here (big children's hospital/academic center), our general pediatrics outpatient clinic doesn't do pelvic exams or birth control. I find this to be ridiculous as I think that these things are part of primary care and are important to patients. But most of our private pediatricians don't do them either. How were/are you all trained and what exposure are you getting outside of the ED?

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[J-Rad]

Dude, I think the rock 'N Roll is fine, but you may want to avoid the sex and drugs in the clinic

Our staff pediatricians would Rx birth control, IIRC. They were somewhat protected from doing pelvics by the residents and the adolescent doc( now since I've left) in the clinic i.e. the adolescent doc was happy to do the majority of routine GYN stuff, but when he was deployed, there were residents that were happy to do most of the pelvics (I was one of them). And, as I said, IIRC most of the general peds people were OK with doing OCP managment for birth control or DUB.

 

[BigRedBeta]

Our general clinic and ado clinic are in separate locations, and for the most part the schedulers do a good job of keeping the patients in the right locations so that protects the gen peds faculty to a wide extent. I don't think birth control would ruffle anyone's feathers, but the pelvics might get referred if they were complaints that we felt could wait.

In the ado clinic, they've gone to doing self swabs for wet preps coupled with dirty urine PCR for GC/Chlamydia, but if the story sounds even remotely suspicious, it's a rare patient that gets out with no treatment, so the test is far more about TOC and follow up. This setup avoids a huge number of pelvics compared to the way things used to be done. My guess is that if I had been required to do pelvics on all the girls I treated for STD's...I probably would have done at least 3 every day I was in ado clinic. As it was, I did probably 5 the whole month. Pelvics are absolutely still done in suspected cases of PID.

 

[Stitch]

We do have one adolescent doc who does some of this, but what gets me is that if there's ANY suspicion for PID, the kid gets sent to me in the ED. I think it's a waste of my staff, and I'm more likely to treat more aggressively since I can't count on follow up.

 

[BigRedBeta]

We do have one adolescent doc who does some of this, but what gets me is that if there's ANY suspicion for PID, the kid gets sent to me in the ED. I think it's a waste of my staff, and I'm more likely to treat more aggressively since I can't count on follow up.

Considering the number of ED shifts we do in my program over the course of our 3 years...thank god our ado clinic doesn't punt there. We get enough exams from abuse cases and abdominal pain in adolescents...

 

[Tone2002]

With the advent of urine chylamdia/gonorrhea, it has made life easier with at minimum a bimanual exam as part of the workup. However I know plenty of privates who do not do pelvic exams under any circumstances. With the new ACOG rules it has made punting easier.

 

[SurfingDoctor]

I didn't really do pelvic in residency, just Tanner staging (that was always observed by a female or male nurse depending on the gender)

I did prescribe birth control and how. I actually had a family refuse to keep coming to my clinic days because I prescribed there 16 year old daugther OCPs but wouldn't tell them if she was having sex or not. They didn't like that answer, so they never came back. Ah... clinic.

 

[TexasRose]

We do have one adolescent doc who does some of this, but what gets me is that if there's ANY suspicion for PID, the kid gets sent to me in the ED. I think it's a waste of my staff, and I'm more likely to treat more aggressively since I can't count on follow up.

Well, that's definitely poor management on the part of the gen peds folks. The EC isn't the place for that. (In the EC you have to do the best you can)

OTOH, that's where I've gotten all my gyn training in pediatrics. Sadly, we get tons of experience with pelvics and STD workups in our county EC.

None of the private docs I work with do full pelvic exams. The reason (excuse) is usually that they don't have the right supplies, exam table, etc and that if they found anything they would have to refer to Gyn anyway.

 

[psychforme]

I didn't really do pelvic in residency, just Tanner staging (that was always observed by a female or male nurse depending on the gender)

I did prescribe birth control and how. I actually had a family refuse to keep coming to my clinic days because I prescribed there 16 year old daugther OCPs but wouldn't tell them if she was having sex or not. They didn't like that answer, so they never came back. Ah... clinic.

more like.... "Ah... rednecks."