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What do you expect at a well exam for a teen?


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#1 Ravin

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Posted 19 May 2017 - 09:39 PM

Today we had annual check-ups for both kids.

Both had their vitals taken, and DS was checked for some basic issues of strength and reflexes, and a nurse had him do an eye exam.

DD the doctor didn't even do that. I expected something along the lines of this:
http://m.kidshealth....yrs.html?WT.ac=

Instead, he checked her vax records, and gave us a prescription for HPV because they didn't have it in stock.

Nothing else.

They also didn't take more than extremely cursory health screening info on either child, beyond asking for an update of DD's current medications, and the screening forms were not targeted at pediatric patients (one was basically an add for a vein center, the other was foot care as expected for diabetic patients). There was no general health screening form, nor were health screening questions asked in the exam room. We received no feedback about how the kids are doing, such as DS's vision screen results or whether their weight/height/vitals looked good.

This was a family practice doctor, but over the last few years, they seem to be skewing more to older people and not whole families.

We also had this doctor for the first time, having switched from another in the practice because DD didn't like her. I was unimpressed.

Am I right to be unimpressed? If we just wanted shots I could have taken them to a minute clinic!

#2 Patty Joanna

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Posted 19 May 2017 - 09:47 PM

I'm unimpressed.

It should be a full physical exam.
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#3 lovinmyboys

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Posted 19 May 2017 - 09:48 PM

That sounds unimpressive to me.

In our area, it does seem like the family practice doctors are full of older patients.
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#4 OneStepAtATime

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Posted 19 May 2017 - 09:50 PM

Very unimpressive.  Makes me wonder if they would have any sort of clue what to do for a child or a young teen if a real issue came up.  


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#5 Sadie

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Posted 19 May 2017 - 10:17 PM

Idk. Well child/teen visits aren't really done here. 

 

 I suppose I'd expect a check to see if vaccinations are up to date, and to be able to raise any health concerns, as well as checks that any prescribed meds were working as required (asthma meds etc)

 

Honestly, I don't even know what a 'full physical' looks like. 

 

 



#6 Cinder

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Posted 19 May 2017 - 10:19 PM

My dc see a pediatrician so their well-checks have been pretty much like what's listed in your link.



#7 klmama

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Posted 19 May 2017 - 11:31 PM

Height, weight, blood pressure, cholesterol screening, and advice on vaccinations.   (ETA:  This is a pediatrician.  I read your link, and the visit was very similar.)

 

 


Edited by klmama, 19 May 2017 - 11:32 PM.


#8 antsam

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Posted 19 May 2017 - 11:44 PM

Last week my son had a well visit/ physical. He's almost 14. Height, weight, vision, hearing, finger prick, check for protein in urine, physical exam (listened to heart, lungs; looked in eyes, ears, nose), hernia check. Updated vaccines if needed.

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#9 J-rap

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Posted 20 May 2017 - 12:06 AM

For my children's 13-year-old check-up they mostly did a thorough health survey, vitals, weight/height, checked reflexes, had them bend over and do a spine check, and made sure vaccinations were up to date.  I can't remember if they checked hearing, but maybe?  Maybe a quick vision check too?  They probably looked in their eyes and ears, and listened to their lungs.  They talked about healthy eating.  They didn't do any kind of lab test.  With my daughters, they were asked about their monthly cycle.  It was pretty basic, but still more than yours.  It seems like for your daughter especially they really didn't do much at all.

 

All my kids only met with general practitioners here.  That's all we have in our town.


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#10 AK_Mom4

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Posted 20 May 2017 - 12:34 AM

My kids always get a sports physical. DD16 just had hers a few weeks ago.  It's a normal full physical checking height, weight, spine, heart, lungs, neck, reflexes.  They do a finger stick and urine test and every other year, they take a vial of blood for some test.  They also check her shot records and make sure she is up-to-date.  For the boys it includes a bend-over and cough type check.  For the girls,  it includes questions about menstrual cycle and birth control.

 

We almost always see either a PA or nurse practitioner at our family doctor's office.



#11 Carrie12345

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Posted 20 May 2017 - 04:53 AM

Ours included spine, finger prick, eyes, ears, and questions about physical activity and menstrual cycle.  Vax records were talked over. I don't even remember if HPV was brought up, specifically. It's something we haven't chosen to do yet. I knew she needed tetanus.  

 

Family practice.


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#12 MEmama

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Posted 20 May 2017 - 05:27 AM

Mine gets the *entire* physical run down, plus they talk about gun safety, possible social concerns and issues, puberty changes, nutrition, sports stuff and so on. I haven't gone in with him for the exam since he was 11 or 12, but the doctor meets with me privately after to review the exam, get the okay for vaccinations, and find out if I have questions or concerns. It's very thorough. DS sees a family practitioner (not a ped).

I assume they will talk about sex safety this year, though I may not hear about that. Lol.

Edited by MEmama, 20 May 2017 - 05:30 AM.


#13 Hilltopmom

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Posted 20 May 2017 - 05:41 AM

Also usually includes screening questions about mental health & drug use, healthy nutrition & exercise habits

#14 Bluegoat

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Posted 20 May 2017 - 06:14 AM

Idk. Well child/teen visits aren't really done here. 

 

 I suppose I'd expect a check to see if vaccinations are up to date, and to be able to raise any health concerns, as well as checks that any prescribed meds were working as required (asthma meds etc)

 

Honestly, I don't even know what a 'full physical' looks like. 

 

Same here.  Pretty much every country besides the US has gotten away from the well-check thing, past infancy.

 

I'd really just expect a record update and a chance fir the teen to ask questions.


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#15 SparklyUnicorn

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Posted 20 May 2017 - 06:21 AM

They do nearly nothing at the well exams here.  Last one my teen had they made sure vaccinations were up to date, read an eye chart, tapped knees, listened to his heart, weight, and height.  Some sort of mental health questionnaire.  That is it. 

 

 



#16 magnificent_baby

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Posted 20 May 2017 - 07:00 AM

Family practice NP here (not my specialty now, but just graduated last year).

 

If this was an annual exam, it should have been a full head to toe exam (or at least the major systems at minimum!), offer immunizations and a conversation regarding at least a few safety and/or development topics. At this age it's common to have the parents step out for part of the exam.

 

If it was a sports physical, some providers make those visits as long as a regular annual exam but focusing on motor strength and heart sounds, while others keep it under ten minutes to cover the necessities.

 

If this was intended to be his annual exam, I would not be happy at all, and even consider asking for a refund for my co-pay if he did not receive a full exam. At minimum please call the office manager. Scary to think he could be missing major health issues with other kids if he breezes through them so fast.


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#17 wintermom

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Posted 20 May 2017 - 07:14 AM

Well child visits are not the same as a full physical here. The time allotted for a dr is about half, or even less if my physical includes a pap test. 

 

Did you book a fully physical? Did you have any specific issues - new or on-going? 



#18 SparklyUnicorn

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Posted 20 May 2017 - 07:20 AM

What gets me is no physical ever included any blood work.  No urinalysis.  NOTHING.  I'm talking about for my kids.  The physicals are super super expensive and they do next to nothing.  It's a total rip.  I basically go because we almost never go to the doctor and in order to have a doctor they kinda wanna see you sometimes.  So that's what I do.  Otherwise, really it feels pointless. 



#19 Where's Toto?

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Posted 20 May 2017 - 07:35 AM

My dc see a pediatrician so their well-checks have been pretty much like what's listed in your link.

 

Us too.   I think they also look at how they walk so have them walk back and forth in the room (dd is still slightly pigeon-toed so that may be why).   We actually "discovered" dd needed glasses at her ped appointment last year.  Since she doesn't go to school, we never noticed she had trouble seeing distances.

 

What gets me is no physical ever included any blood work.  No urinalysis.  NOTHING.  I'm talking about for my kids.  The physicals are super super expensive and they do next to nothing.  It's a total rip.  I basically go because we almost never go to the doctor and in order to have a doctor they kinda wanna see you sometimes.  So that's what I do.  Otherwise, really it feels pointless. 

 

We got sent a few times when they were younger for lead tests.  I think they only suggest it now every few years or if they see signs of an issue.


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#20 magnificent_baby

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Posted 20 May 2017 - 07:47 AM

What gets me is no physical ever included any blood work.  No urinalysis.  NOTHING.  I'm talking about for my kids.  The physicals are super super expensive and they do next to nothing.  It's a total rip.  I basically go because we almost never go to the doctor and in order to have a doctor they kinda wanna see you sometimes.  So that's what I do.  Otherwise, really it feels pointless. 

 

Our pediatrician is super conservative when it comes to testing, it really seems to be a trend in general. I was concerned about a few symptoms at our last visit and he said those symptoms don't warrant blood work. He's overall very thorough so I'm okay with that at this point even though I wanted to roll my eyes.

 

We've also been to the ER twice recently with DS for a concussion with ongoing symptoms and no CT scan either time. I was not happy with that at the time, but they were following current guidelines and finally 4 weeks later his symptoms are gone.


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#21 Attolia

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Posted 20 May 2017 - 07:47 AM

Wow, seriously unimpressed.  My teens still see their pediatrician and they have certain topics they cover at certain ages.  My daughter will be a college freshman in the fall and her NP even talked to her about the dangers of party culture (not accepting drinks or candy from anyone and not leaving your drink unattended because someone might slip something into it), she talked about being aware of surroundings because of the high incidences of rapes on some campuses.  She encouraged her to have family location sharing on, to always walk with a friend at night, etc.  She also did a thorough exam on DD - listening to heart and lungs, etc.  

At every teen check, they talk about healthy habits like choosing healthy foods, not consuming too much sugar, making sure they get plenty of activity, avoiding drugs, etc.


Edited by Attolia, 20 May 2017 - 07:49 AM.

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#22 whitehawk

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Posted 20 May 2017 - 07:50 AM

DS goes to a ped, and it's pretty much like the link--height and weight (and his growth curve is overlaid on the typical chart so I can see on the laptop), look in ears and throat, palpate abdomen and genitals, talk about nutrition and safety issues for this age, update vaccines if needed, test cholesterol certain years, discuss any concerns. They checked vision at age 5 because the state wants that for K entry.


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#23 Farrar

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Posted 20 May 2017 - 07:57 AM

We had a similar experience last time at our practice after the person we usually see retired. I even got into the most absurd back and forth where he refused to give the kids the HPV vax without also giving them the flu vax. I wanted them to get the flu vax, but not the day before they each had opening night for shows - it was right before ds started with 12 show run for Nutcracker and they also feel under the weather after they get the flu vax and they just couldn't right then. I explained this, then he said, so I'll send in the flu vax. I was like, no, I'd like to come back and get it in a few weeks. Okay. I'll send in the flu vax. Um, are you listening?!? Can we just get the HPV we're due for. Okay, so no vaccines now. Sigh.

 

I had a list of concerns to talk about and he literally walked out in the middle. Of course, by then, I was pretty well done. He also didn't do any of the things we were used to.



#24 magnificent_baby

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Posted 20 May 2017 - 08:08 AM

Well child visits are not the same as a full physical here. The time allotted for a dr is about half, or even less if my physical includes a pap test. 

 

Did you book a fully physical? Did you have any specific issues - new or on-going? 

 

Really? They should be the same as a full physical, at least a quick exam on each major system at minimum. On kids I wouldn't do a full neuro or palpate the thyroid, but otherwise it should be similar. That's concerning if they aren't doing the bare minimum. Bright Futures is the standard to follow and is very age specific, they have a very nice website you want to find out what should be addressed.

 

Something I couldn't get used to when I was in NP school was not addressing specific symptoms and suggesting a follow up appointment for other issues. For my kids I have always kept a list of concerns (non-acute of course) and addressed them at the annual since we rarely see their primary docs. We use the walk in clinic for acute problems. That didn't seem right to me, but I understand since many insurance companies will not pay for other services on the same day as wellness exams.



#25 TX Native

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Posted 20 May 2017 - 08:09 AM

Family practice NP here (not my specialty now, but just graduated last year).

If this was an annual exam, it should have been a full head to toe exam (or at least the major systems at minimum!), offer immunizations and a conversation regarding at least a few safety and/or development topics. At this age it's common to have the parents step out for part of the exam.

If it was a sports physical, some providers make those visits as long as a regular annual exam but focusing on motor strength and heart sounds, while others keep it under ten minutes to cover the necessities.

If this was intended to be his annual exam, I would not be happy at all, and even consider asking for a refund for my co-pay if he did not receive a full exam. At minimum please call the office manager. Scary to think he could be missing major health issues with other kids if he breezes through them so fast.


I so agree with this. Especially the last paragraph.

#26 OneStepAtATime

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Posted 20 May 2017 - 08:16 AM

We had a similar experience last time at our practice after the person we usually see retired. I even got into the most absurd back and forth where he refused to give the kids the HPV vax without also giving them the flu vax. I wanted them to get the flu vax, but not the day before they each had opening night for shows - it was right before ds started with 12 show run for Nutcracker and they also feel under the weather after they get the flu vax and they just couldn't right then. I explained this, then he said, so I'll send in the flu vax. I was like, no, I'd like to come back and get it in a few weeks. Okay. I'll send in the flu vax. Um, are you listening?!? Can we just get the HPV we're due for. Okay, so no vaccines now. Sigh.

 

I had a list of concerns to talk about and he literally walked out in the middle. Of course, by then, I was pretty well done. He also didn't do any of the things we were used to.

Uh, wow.  Gee that was helpful.  Thanks, Doc, for listening and for acting like your patients matter and have brains.


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#27 scholastica

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Posted 20 May 2017 - 08:18 AM

Wow. Now I love my pediatrician even more. She does a very thorough well exam every year. Head to toe, full physical exam and talks to them about sleeping, eating, school, friends, screen time, activities, menstrual cycle if they are girls. She asks them if they have any concerns and then asks me if I have any concerns. Your child did not get an exam, she got a cursory look.
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#28 magnificent_baby

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Posted 20 May 2017 - 08:24 AM

Wow. Now I love my pediatrician even more. She does a very thorough well exam every year. Head to toe, full physical exam and talks to them about sleeping, eating, school, friends, screen time, activities, menstrual cycle if they are girls. She asks them if they have any concerns and then asks me if I have any concerns. Your child did not get an exam, she got a cursory look.

 

Ours too! The wait time is extremely long (last appointment we waited 1 hour after our scheduled time) which is not unusual. But by the time he gets in there he is so thorough, I overlook the wait.



#29 Murphy101

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Posted 20 May 2017 - 08:33 AM

I just took my 16 yr old dd this week.

Weight
BP
Menstration
Vaccinations
Did we have any questions or concerns? (We didn't)
Anemia wasn't a concern (though as someone who was anemic most of my life, I know the signs and was aware that some of questions were related. Unusually tired even when getting plenty of sleep, moody, heavy periods questions. Checking skin tone and eyes.)
Asking about sexual activity and being sure she understands basic sex and concerns with sexual activity whether it be consensual or not (stds, pregnancy and abuse questions)

This will probably be her last spot with our pediatrician. I need to find a gyno for next years check up.

She got 6 shots though bc I'm a later vaccinater and we discussed that and the shots with the dr.

#30 Farrar

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Posted 20 May 2017 - 08:49 AM

Uh, wow.  Gee that was helpful.  Thanks, Doc, for listening and for acting like your patients matter and have brains.

 

I've had this treatment for *myself* from doctors all the time. But it was a little jarring to see it in pediatrics - we've always had an excellent practice, but it closed down. :(



#31 OneStepAtATime

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Posted 20 May 2017 - 08:50 AM

I've had this treatment for *myself* from doctors all the time. But it was a little jarring to see it in pediatrics - we've always had an excellent practice, but it closed down. :(

Well that stinks.  


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#32 scholastica

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Posted 20 May 2017 - 08:59 AM

Ours too! The wait time is extremely long (last appointment we waited 1 hour after our scheduled time) which is not unusual. But by the time he gets in there he is so thorough, I overlook the wait.


We don't even have to wait. This is the most efficient and well run medical practice I've ever seen. They allow ample time for well visits. They are really good at what they do! They are one of the reasons I don't want to move anywhere until my kids have outgrown the need. I gave up an awesome primary care doc for me when we changed insurance so that we could stay there.
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#33 scholastica

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Posted 20 May 2017 - 09:00 AM

I've had this treatment for *myself* from doctors all the time. But it was a little jarring to see it in pediatrics - we've always had an excellent practice, but it closed down. :(


That is awful. I'm sorry. I hope you can find a better practice for your kids.

#34 Ravin

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Posted 20 May 2017 - 09:08 AM

I didn't even mention that it was an hour and a half after the scheduled appointment time that we finally saw the doctor.

#35 brehon

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Posted 20 May 2017 - 09:11 AM

My kids see a pediatrician.

My 15 yo ds had a UA, hernia check, vaccs check w/a couple administered, vision test, height/weight, & a physical exam (spine, reflexes, major systems, etc). Doc (male) also talked about safety (all inclusive) & other topics, including topics about sexuality, STDs, etc.

My dd13 had the same as her brother minus the hernia check and with the addition of a conversation about menstruation.

ETA: My younger kids get all of the above with or without vaccinations (we space them out more) and obviously any conversations are tailored to the appropriate age of the child.

Edited by brehon, 20 May 2017 - 09:18 AM.

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#36 MEmama

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Posted 20 May 2017 - 09:49 AM

Well child visits are not the same as a full physical here. The time allotted for a dr is about half, or even less if my physical includes a pap test.

Did you book a fully physical? Did you have any specific issues - new or on-going?

Our well child visits are the same as a full, annual physical, with the addition of kid specific issues and checks. Our doctors are phenomenal--they take as long as you want, are extremely thorough and never rush. I'm amazed at how much time they take, actually, since it's a full service office. The doctor sees me privately directly after he sees DS to discuss the check up.

Eta: no ongoing issues

Edited by MEmama, 20 May 2017 - 09:50 AM.

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#37 slackermom

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Posted 20 May 2017 - 11:13 AM

My child was seen at an adolescent clinic last year, and we are officially switching over to them instead of the pediatrician this year, at 13. It was booked as an "intake visit," which is more extensive than a well check or a physical. They did a full review of systems, including blood and urine, which apparently checks for certain drugs. It also included a screening with a mental health provider and another screening with a nutritionist. I think in the future we just see the MD for the annual exam.

#38 SparklyUnicorn

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Posted 20 May 2017 - 11:27 AM

I didn't even mention that it was an hour and a half after the scheduled appointment time that we finally saw the doctor.

 

That bites...

 

That's one thing I can't complain about.  We never end up waiting there. 



#39 madteaparty

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Posted 20 May 2017 - 02:36 PM

What gets me is no physical ever included any blood work. No urinalysis. NOTHING. I'm talking about for my kids. The physicals are super super expensive and they do next to nothing. It's a total rip. I basically go because we almost never go to the doctor and in order to have a doctor they kinda wanna see you sometimes. So that's what I do. Otherwise, really it feels pointless.

But do kids need blood work/urinanalysis as a matter of course?
To the OP: we see a family practitioner and all go at the same time. It takes all of 5 min for my DS appt but most things listed in the link are done.

#40 Murphy101

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Posted 20 May 2017 - 04:26 PM

But do kids need blood work/urinanalysis as a matter of course?
To the OP: we see a family practitioner and all go at the same time. It takes all of 5 min for my DS appt but most things listed in the link are done.


In 22 years of babies and children, none of mine have ever had urine/stool or blood work done at physicals or well checks. Ever. The most invasive thing they ever had was a vax shot or a finger prick for iron. If we had any other tests done, it was because something was a concern or there were other issues to warrant it.

Dh and I didn't get any general blood work done either until we hit our forties, with exception of when I was pregnant.

#41 Ravin

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Posted 20 May 2017 - 05:25 PM

Part of what bothers me is that while I expected DS's to be perfunctory because he's healthy as a horse, DD is not and has several chronic illness and MH diagnoses. They asked about none of it.

And instead of getting the shot over with, she now had time to work up more anxiety over it until I can ID a pharmacy that will do it.

#42 SKL

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Posted 20 May 2017 - 07:00 PM

My kids are only 10, but I would say it does not surprise nor bother me.  In my experience, if I want the doc to so much as make eye contact with me, I have to tell them what I want.

 

I didn't do well checks for my kids for a number of years, because I found them rather useless.  However, I took them in recently, to establish care at a new practice, and because I thought they needed a shot for 6th grade.  (I was wrong on that.)  We were not seen by a doctor at all, but a nurse practitioner - fine, she probably gave us more eye contact than a doctor would anyway.  She asked the kids if they used their seatbelts and brushed their teeth, did they have friends, and to me, were they pleasant to live with.  The usual height/weight was done, and their computer spit out a BMI and percentiles.  The usual looking in the eyes, ears, blood pressure, pulse.  No vision screening or anything similar (not that I expected that).

 

What she did NOT do, that seemed odd after the fact, was ask about past vax history.  Not that I'd thought to bring that with me.  :p

 

And the other thing that was weird to me and my girls.  I mentioned they were in early puberty stages.  She put her hands on them to check inside their underwear - I guess to gauge how far along they were in puberty.  I'm not sure how invasive she got down there, but it was very unexpected and uncomfortable for all of us.  Note to self:  tell people in future that they need to tell the girls in advance if they are planning to touch them.



#43 scholastica

scholastica

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Posted 20 May 2017 - 08:09 PM

My kids are only 10, but I would say it does not surprise nor bother me. In my experience, if I want the doc to so much as make eye contact with me, I have to tell them what I want.

I didn't do well checks for my kids for a number of years, because I found them rather useless. However, I took them in recently, to establish care at a new practice, and because I thought they needed a shot for 6th grade. (I was wrong on that.) We were not seen by a doctor at all, but a nurse practitioner - fine, she probably gave us more eye contact than a doctor would anyway. She asked the kids if they used their seatbelts and brushed their teeth, did they have friends, and to me, were they pleasant to live with. The usual height/weight was done, and their computer spit out a BMI and percentiles. The usual looking in the eyes, ears, blood pressure, pulse. No vision screening or anything similar (not that I expected that).

What she did NOT do, that seemed odd after the fact, was ask about past vax history. Not that I'd thought to bring that with me. :p

And the other thing that was weird to me and my girls. I mentioned they were in early puberty stages. She put her hands on them to check inside their underwear - I guess to gauge how far along they were in puberty. I'm not sure how invasive she got down there, but it was very unexpected and uncomfortable for all of us. Note to self: tell people in future that they need to tell the girls in advance if they are planning to touch them.


Our ped always checks the private area. She always prefaces it with "I'm going to check your private area now. This is only okay because I'm your doctor and your mom is here." I can't imagine not warning the child beforehand or telling you.