A pediatrician speaks out against combining sibling appointments

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Imagine your typical yearly physical. It’s probably booked for 20 to 40 minutes. Since you, like many of us, may see your physician only once a year, it is important for you to have your physician’s complete attention and to have all of your concerns addressed. Some of these concerns may be of a sensitive – even embarrassing – nature. Your physician may likewise ask you some probing questions about matters you consider private. None of this is out of the ordinary for a typical annual physical.

Now imagine bringing your friend with you for that visit. He’s not there as support for you, or a ride; he has an appointment with the same doctor at the same time! On paper, his appointment is after yours, but you go in at the same time, and your history and exam end up blended together. On top of that, his medical history is more complex than yours, so he necessarily takes up more of your doctor’s time and attention, and since he’s naturally chattier he is happy to jump in and provide his own answers to questions your doctor asks of you. And privacy? Forget about it.

I hope this imaginary scenario strikes most people as entirely nutty, not to mention entirely avoidable. Who would book their annual physical with another person?

I’m a primary care physician, and I encounter exactly this scenario daily. In fact, over the summer, I see it played out in my office, on average, 4 or 5 times per day.

I’m a pediatrician.

Many of our patients come to see us once a year, often during the summer when school is out. If they have siblings, they are very frequently booked together, sometimes even 3 or 4 at a time. Parents think nothing of having their 14-year-old daughter undergo her annual physical in the same room and at the same time as her 9-year-old sister and her 7-year-old brother (with asthma and ADHD), even though they would never think of doing the same thing with their own health care. Why is that?

I know the answer: convenience. I get it. I have two kids myself. Just book them together and get it all done in one trip. Why not?

Our kids deserve better, that’s why not. They deserve the same amount of time and attention as an adult patient. For obvious reasons, children are seen with parents or other caregivers, but there is no reason they must be seen with other siblings. Yes, even twins! Twins are people too, people deserving of the same basic dignity and autonomy as any other patient. But when I’ve gently suggested to parents of twins or other siblings that they should consider bringing them in separately, they look at me as if I have three heads.

I’ve been standing on this soapbox for years, but a recent example drove home the point for me. I had two siblings, new patients, booked for physicals: a 13-year-old girl and a 7-year-old boy. They had two 20-minute appointments back to back, but showed up about 10 minutes late, so I had 30 minutes to meet them and complete new patient physicals, together. While it was not my intention initially to discuss any sensitive issues that could embarrass the girl in front of her brother, one of the first things their mother asked me was whether I thought the girl was done growing. I explained that without growth curves (this was her first visit with us), it might be hard to say, but we could use other information like a calculated mid-parental height and also her pubertal progression to help say whether she had any substantial growth left.

This naturally led to a brief discussion of normal puberty in girls. I received a comment card from the family later that took me to task for making both the girl and her brother uncomfortable by discussing her puberty with her brother present. The family might not have anticipated that a question about growth could lead to a discussion of development, but the entire situation could have been avoided by giving the girl the benefit of a doctor’s visit in which she was the only patient. They could have been booked on different days, or with different parents. We could have asked the boy to step out, but the family wasn’t comfortable with a child that young being unsupervised in the waiting room. I assume that when the girl is 30, and her brother is 24, they won’t have their check-ups together. Asking them to do it that way now is no less preposterous to me, and it is denying them a part of their basic humanity just because they are children, which is antithetical to the entire field of pediatrics.

Privacy aside, even with younger children and infants, it is too easy for us just to bundle them together. If two toddlers come to see me at the same time, invariably one is more complicated than the other, or one is crying and fussing more than the other, which unfortunately prevents me from giving all the deserved attention to the other child.

I am unfortunately bound by my office’s policies, which includes giving parents the convenience they seek, so we don’t restrict the booking of multiple appointments together. But parents, I implore you: Consider treating your kids the way you would want to be treated.

The author is an anonymous physician.

Image credit: Shutterstock.com

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