The rant: The office zoo, shooting from the hip

March 2005

My office actually runs very smoothly most days, and I can imagine no other career that I would enjoy more, or that would provide such fulfillment. However, there are moments!

The purpose of this opinion piece is for me to vent — to explain those occasional peccadilloes in my office or my life that drive me to the ranting of a King Lear. Perhaps you may agree with my pet peeves. Remember that the rants are not to belittle my young patients, as they are probably perfect. Rather, most of these transgressions originate from parental or societal cluelessness or indifference.

Teen raptors of rapture

I am always highly alarmed when parents allow a daughter to start “dating” a male 2 years older than she is during high school. Having raised four young daughters and cared for countless teens in my practice, I am a seasoned warrior. If one of our goals when treating adolescents is to postpone sexual involvement — at least until after high school graduation — then parents and young teens should be forewarned about the perils of this age discrepancy.

	“It’s either parental tough love early, or daughter tough luck later.” — Stan L. Block, MD

In most states, a 14-year-old or 15-year-old female becoming sexually involved with a 17- or 18- year-old male is legally considered sexual abuse or statutory rape. And yet, in the National Longitudinal Survey of Youth, at age 15, the first sexual partner of experienced females was “typically” three years older — clearly a worrisome statistic. Sadly, the reason for first intercourse for these females was stated as “to please the partner” (20%), “my partner forced me” (15%) and “did not wish to engage in it” (25%). Importantly, 70% of female adolescents sexually involved by age 16 reported later that they wished they had waited longer — clearly at this age, an impulsive and often coercive act usually regretted.

Thus, early intercourse for young females in high school often results from a sexual predator situation. My personal observation in my mostly white rural population is that when the female-to-male age discrepancy is more than 2 years, sexual activity assuredly will occur within six months of the relationship’s start. And we should counsel them accordingly. These young girls are also at much higher risk for sexually transmitted diseases, cigarette and drug use and, of course, teen pregnancy. I also observe a very high frequency of total male dominance and serious male jealousy issues in these relationships, and the stifling of the girl’s healthy emotional and social growth in high school. Most of these girls are placed under a social Marshall Law (under the thumb of the boyfriend) and become stressed-out and miserable while in this relationship.

Suggestions: Have parents swoop down raptor-like and confront the daughter’s dating life. It’s either parental tough love early, or daughter tough luck later (babies, partner abuse, drugs). As the poet Robert Graves noted: “Love may be blind but Love at least, / Knows what is man and what is mere beast.” These young girls are blinded by the “prestige” and “social security” of the older raptor. They too often become impulsively involved and relinquish control of their social lives and sexuality. Otherwise, parents may become premature grandparents or start paying for daughter’s psychotherapy. Personal pearl: Each of my daughters was warned that during high school, dating of any male 12 months older was not allowed under my Marshall Law. Too many other younger male fish in the sea for them to become oppressed bait and to spawn all types of other regretful high-risk behaviors and consequences in high school.

Gummy bears and office grazing

The epidemic of dental caries in practice is staggering. Too many children walk around all day at home or in the office with a bottle, sippy-cup or bag full of Cheerios or gummy bears. Not only is this disrespectful of the office/home cleanliness, as they spill their liquids and solids on our floors, but it truly destroys their tooth enamel, rots teeth to the “gummies” and predisposes to obesity.

Suggestions: Have a sign in each room stating “no food or drink in the exam rooms.” Counsel all parents of toddlers about the need for children to eat or drink only at the kitchen table and to have nothing by mouth in bed or after parents brush the child’s teeth at night (except water). Dispose of the bottle forever after 12 months of age.

Pack of wild jackals

Discipline and the total lack thereof. Ever watch the children on “Super Nanny”? This has to be the best show on television for parents. Well, children of that elk, er ilk, seem to permeate the office on some days. Unruly, petulant and demanding, this overindulged child has no respect for you, your property or the (usually ineffectual) mother. These are the same “sweethearts” who are insomniacs and whom parents insist must sleep in their bed to assuage both parties. Talk about an eventual sure-fire visit to divorce court!

Suggestions: parental discussions, AAP booklets and books about discipline; forecasts such as, “You think the tears are bad now when you tell your child NO — wait ‘til you try saying NO at age 14 or 15 when their future is on the line.” And emulate the “Nan” in action.

Phone-us interruptus birdies

What is the aural fixation that mesmerizes parents and teens into believing that any warbling that emanates from their petite single-winged flip-up phone is more important than anything you have to say? Surprisingly, they can obtain reception anywhere in the recesses of our office. And of course, hearing other little birdies chirp about the latest gossip is much more entertaining than and always takes precedence over an antibiotic discourse or a synopsis of herpangina. They can always just call us back and ask questions to the phone nurse later. The doctor should have time to peripherally listen to the latest lovers’ spat or when to pick up the little chickies.

Suggestion: Sign in each room that says, “Turn off all cell phones.” Or insert wireless phone jammer in your office.

Go-fer two-fer

I really need the antacid when this ugly gopher-beast pops its head during the visit. “Oh, by the way, Doc, could you just look at lil Johnny’s brother’s … rash, ears, lungs, belly, [fill in the blank]” This is the perpetual “innocuous” two-for-one phenomenon that parents love to spring on us good-natured, nonconfrontational pediatricians.

Suggestion: No longer do we just “go-fer” it. Put a sign in each room: “We are obligated to ask the nurse to obtain the chart, vital signs, history and charge slip for the two-fer or add-on child. We are medically and legally bound to do so. We will be ‘happy’ to see the child if time allows and in the next available time slot. Thanks for helping us with our busy schedule.”

Even our nonpaying Medicaid patients usually respect this.

Herd immunity: Nonvaccinators

Most parents who believe in nonvaccination also truly believe that vaccines are important for everyone else’s child to receive, to prevent their own child from getting ill with vaccine-preventable diseases. They are just too smart to allow the doctor or government to force (trick) them into taking any risk for a vaccine adverse reaction in their child. As Blanche DuBois stated in “A Streetcar Named Desire,” “I have always depended on the kindness of strangers.” The same can be said for most nonvaccinators. The only problem is that these children are a (preventable) potential infectious disease biohazard (think measles, pertussis) in your office and waiting room for all those unvaccinated newborns and infants. Thank goodness we asked the children of our chiropractor to seek care elsewhere a few months before his 4- and 6-year old children acquired pertussis. This could have devastated some of our infants.

Suggestion: Reinforce the following additional vaccine concepts: the necessity of herd immunity, “The Golden Rule: Do unto others as you would have them do unto you” and the strict office policy of prevention and avoidance of unnecessary aerosol biohazards.

Boots of pig farmers

Porcine olfactory wonders that linger for hours are best left outdoors. Ah, the perils of rural pediatrics.

Pork barrel politics

Speaking of pig stuff at the trough, our state legislature, like many other state legislatures around the United States, has recently legalized the performance of high school sports physicals by chiropractors. The medical lobbyists were asleep when this occurred. And this legislation was purchased fairly cheaply. Who cares about medical science, the powers of auscultation, seven years of medical training, screening for real diseases and ensuring physical fitness for contact sports? Check for proteinuria, an absent testicle, vision defects, aortic stenosis or tetanus vaccination? Why, these are not important, when most backs (and I am not talking fullbacks or tailbacks) are misaligned and need diagnostic radiography and manipulation. Next, let’s allow the spine-guys on the sideline to evaluate players who get injured: spine adjustments for that anterior cruciate ligament tear.

Suggestion: Send them to medical school first, if they want to play like doctors in the big game. This could be the one and only chance for malpractice attorneys to contribute positively to the health care of Americans.

Teaching new tricks to old dogs

I can’t express how overjoyed a parent can become when listening to the 6 p.m. evening news daily. With the opportunity to learn not only about the latest war or tragedy or economic or health care crisis, we must also DAILY endure a barrage of dinnertime commercials to cure one of the hazards of aging. The big pharmaceuticals should be ashamed! Talk about destroying quality family dialogue with your high school or middle school daughter (two in my household). Look forward to a nightly dinner discussion with your 16-year-old daughter about the critical importance of Levitra (vardenafil, Bayer) or Cialis (tadalafil, Lilly ICOS) “Daddy, what is ED?” “I dunno, go ask your mother?”

Suggestion: Wake up FCC! This advertising abomination belongs long after bedtime hours. This is tenfold worse than the Janet Jackson exposure. How about a stiff fine for their really bad taste and their license to licentiousness!

Of course, these are just my opinions; I could be wrong — to paraphrase Dennis Miller in “I Rant Therefore I Am.”

For more information:

• Dickson N, Paul C, Herbison P, Silva P. First sexual intercourse: age, coercion, and later regrets reported by a birth cohort. BMJ. 1998;316:29-33.
• Paul C, Fitzjohn J, Herbison P, Dickson N. The determinants of sexual intercourse before age 16. J Adolesc Health. 2000;27:136-147.
• Shrier L, Emans SJ, Woods ER, DuRant RH. The association of sexual risk behaviors and problem drug behaviors in high school students. J Adolesc Health. 1997;20:377-383.
• Friedman S, et al, eds. “Comprehensive Adolescent Health Care.” St. Louis, Mo: Mosby; 1998: 50-54.

• Stan L. Block, MD, has a pediatric practice in Bardstown, Ky., and is a member of the Infectious Diseases in Children Editorial Advisory Board.