Monday, March 21, 2011

How a 12/13 year old boy made me feel violated today.

The last station of my Paediatrics clinical exam was to examine a 12/13 year old boy who was lying in bed, the doctor was sitting at a desk on the patient's left hand side and I was standing on his right.

During the examination, as i was examining his right hand, the doctor started talking to me. I lay his hand back on the bed, and my hand was resting a small distance away from it.

The boy then reaches for my hand and starts stroking it slowly, so I move my hand away, the doctor was still talking. He follows my hand and keeps tracing my hand with his fingers, and I move it away again, and he follows. Having moved my hand away three times now, I just crossed my arms.

I honestly feel violated, and traumatized. Washed my hands a dozen times since. He's a child, I don't understand. I'm disgusted.

20 comments:

  1. Sometime you need to point the elephant in the room.

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  2. That's scary coming from a 12 year old O.o
    Damn you puberty hormones! xD

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  3. that's disturbing, and I understand you didn't want to cause a scene while undertaking an exam! Why you haven't reported it?

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  4. What if he just liked you? What if he is "just a twelve years old" who really liked you?

    How often are boys in his age allowed normal contact with their women anymore? Maybe his mother doesn't touch him kindly often enough anymore. Maybe he just missed gentle physical contact.

    And it "just" came out in a wrong & desperate manner.

    I don't blame your reaction. I'm sorry...for both of you.

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  5. Duha: not in the middle of an on-going exam. proly talk to the leader about it.

    Recosan: I dont know if it's puberty or as Hning said in her comment...

    Meaad: I'll tell my group leader and see what she thinks is the best approach.

    Hning: could be! what i'm really afraid of is that he may have been sexually abused, but I can't bring that up just because of this one sign.

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  6. can he talk
    is he trying to tell u something?

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  7. i am pretty sure that he has a story now that made him the coolest kid in his class

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  8. Hning said better than I ever could! but it is certainly strange!

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  9. Abdullah: sadly, yes.

    Nada: exactly what Alia said, but then, can't rule out molestation too. low socio-economic status, parents not well educated, living in the outskirts of a town... it just scares me what may have made him do that.

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  10. Hi,

    I agree with Hning, the reason for this could be an ocean of things other than a mere inappropriate acted out infatuation.
    The best doctors, in my humble opinion, are the ones that take the time to spend with their patients, if that kid is still around it wouldn’t hurt anyone if you went to talk to him like an older sister/friend, if he's a lil ‘’perv” then that’s what he is, but if he's just a kid reaching out then you would have done him a great service.

    Good luck either way.

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  11. My best guesses would be early adolescent exploring and testing limits, in someone smart enough to know you wouldn't feel comfortable confronting him, especially during an exam, with the added thrill of doing it to a doctor and making her uncomfortable (see delusions of grandeur, erotomania--all this being at the normal to mildly neurotic level).

    Adolescents, including those coming up to puberty, tend to do a lot of exploring in reality and online of things that if they were entrenched adult behaviours would be questionable. Otherwise, the usual advice is to make clear the behaviour is inappropriate and should stop, then leave it alone.

    Eg, watching gay porn on a computer younger children have access to--that was a family friend whose mother and father freaked. The mother was so freaked and couldn't talk about it, even after my kindly "I'm a shrink, I've heard everything and I would keep this totally confidential" that I was starting to imagine zoophilia, and a friend of mine, also a shrink, was thinking of murderous impulses and online advice.

    I told the mother to consult their pediatrician who told her it was normal, not an indication of anything other than curiosity, and to restrict his computer privileges for the month as planned and harangue him about the younger kids as was already done, then leave it alone. He is now a successful med student with a live in girlfriend, and about to head off to a surgical specialization. (on psych testing this passes as normal LOL :D :P)

    As for the sexual abuse, I would be careful about jumping to conclusions or taking actions which can have longterm consequences, especially if you are not involved in his ongoing care, and don't have the opportunity to get a fuller history.

    In regards to reporting it within academia, if you do so, I would be careful to indicate you handled the situation well/appropriately (you did), and are unintimidated by it (being upset and intimidated are different), but would like feedback as to whether you could have done something more. Beware the "ah hah, if you want to be a doctor you women will have to learn to put up with...or stop taking up the positions men should rightfully fulfil..." people. :D

    As for saying something at the time, it was probably best to leave it alone. You might have excused yourself to the professor and turned to the boy and said as sincerely as possible "I'm sorry, was there something you wanted to let us know?". However, he might have died of embarrassment (whatever false bravado he mustered), and your first obligation is "to do no harm".

    Overall, I think you handled it well, and are dealing appropriately with one of those "off the standard curriculum" lessons that clinical practise teaches us. Sort of like:

    Oh this neurosurgeon with the exquisite French language skills is reading you poetry he wrote after your first session last week, which is well written, hmmm rather erotic, hmmpf rather explict, oh! all about performing cunnilinctus on me! And it is late on a Friday evening, in a building that is mostly empty with occasional security rounds. Best to transfer his care, and not tell the hub about this."

    Not mentioning any names! :D

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  12. Abdulaziz: I spend 5 minutes with each mock patient. I asked him for his name before examination, I'm not sure if this is his real name or the name the examiners told him to tell me. The mock patients come into the hospital for the duration of the exam then leave, i can't "find" him again since he's not a real patient. it's up to his parents.

    Chiara: THANK YOU!! i guess i was just hoping children would remain innocent much longer.

    Judging from the normal population referred to our hospital, he probably only heard about any sexual acts from older boys, in a part of society that encourages men to have 4 wives. He Probably has 4 mothers and none of them paid him any attention until he was called to be our mock patient.

    And yes, i wont be hasty to report sexual abuse, even though after the shock wore off he really got me concerned. Paediatrics is such a problematic department at our hospital, i'm not sure if there ever will be a good time to discuss this with the doctors, and i probably won't be able to find my mock patient again, I never saw a mock patient again at the hospital.

    The Saudi version of this Neurosurgeon would be the Professor who is known to marry students! two students so far, and his 1st wife works at the college administration. After marrying his 2nd student he announced to her class during a session to "send your best wished to your friend xxxx, I just married her!". Such audacity! And people keep saying: "but he married her in the proper Islamic manner" ... apparently "ethics" is not a term they're familiar with.

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  13. Hning opinion seems to be interesting.

    Also, it could only be an act of childish misbehavior rather than an act of harassment.

    Abdulaziz sister/friend little talk is a good suggestion too.

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  14. Saad: Hning's opinion is interesting, but i lean more towards Chiara's opinion.
    And I think the sister/friend talk is a bad idea, primarily because i am not his physician and i am not familiar with his social background. We're both very aware of the broad variations in our society, and he's more likely to come from one where he's never seen his grandmother's face, acting "friendly" to him could be interpreted in a million ways. Thus I think the only way I would've spoken to him was with both parents present and his physician, in a professional manner.

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  15. After reading the further details you added in reply yesterday, I was going to write that you handled the situation perfectly, and should now file it under "stories to tell at medical conferences when I accompany my physician granddaughters there".

    In light of Saad's comment, and others, about trying to address the inappropriateness of his behaviour, I still think you handled it perfectly.

    He was well aware that he was misbehaving and testing limits, I'm sure. By moving your hand away you indicated that such behaviour was not allowed. By folding your arms you gave a clear communication that you weren't teasing, and that the behaviour is not allowed and will stop.

    The non-verbal communication on both your parts was loud and clear.

    Overall your purpose there was to continue on your path towards being a physician, and it is best to have focused on that, and not allowed yourself to be unduly distracted.

    To the extent that the boy may have been trying to put you in your female place, he failed.

    All interactions with a pediatric patient should happen with at least one parent present. All the more so in a gender segregated and conservative society.

    As you say, such a delicate topic would warrant having both parents present, and in that kind of a situation I would have a supportive more senior male physician in on the session as well. There is too much room for misinterpretation and false accusations otherwise.

    You would have to agree with the senior male physician before hand on how to handle the interview, and be sure he would back you up no matter what you were accused of.

    You are right that in a consultancy situation having the regular or attending physician present would be desirable or even necessary.

    Your best defense, and most importantly, your best guide to appropriate clinical action is your professionalism.

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  16. Find the largest syringe, preferably one with those metal handles, get close to him, while reading the chart slowly... take your time.

    He will then ask, what and why... don't answer and seemed confused, then ask if he was told that he will need to take this in his eye or neck because you can't find that on the chart... squeeze the syringe a couple of times.

    Then leave the room, saying you will come back... but of course u don't ;)

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  17. If it's really harassment - can u widen your eyes, slap his hands as a no. At least he's a kid. There's a Dr here who has it so much worse :P from an old man. He said he's sick in love with her... I imagine she warns him with a syringe or something.

    there's always non textbook ways to deal with this stuffs.

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  18. The syringe idea is a great fantasy, but I would save it as a fantasy for an obnoxious adult med-surg patient under your ongoing care, with no history of hypomania or mania.

    Re: slapping the hand of a 12-13 year old. Not during a 5 minute exam station. Probably not ever, especially if you do any part of your training in North America where it would constitute assault on minor, is a reportable offence (any licensed professional would be required to report it), and children are indoctrinated from kindergarten to report such an assault to a responsible adult in an authority position.

    Fun to imagine though! :D

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  19. Have to agree with Hning.

    Don't get me wrong, but isn't the first, foremost and the most important aspect of being a medical practitioner is to comfort your patients? A 12/13 years old boy tries to touch your hand while laying sick on bed waiting to be treated, and it disgusts you!?? woah!! And the first thought that goes to your head is that the poor sick guy is trying to violate you!?? I guess we have to change our own mentality.


    Lucky that you are a medical student in KSA, civilized countries would expel their medical students on such thoughts.

    And don't get me wrong as i didnt want to sound negative. I am a regular follower of your blog. Just wanted to let out a few words.

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  20. Shahid:

    First of all I'll have to explain that he isn't a patient, he is a mock patient. He isn't ill, he is simply a bored adolescent.

    a 12/13 year old boy living in Saudi Arabia knows that such behaviour is unacceptable, he's just trying to see how much he can get away with.

    Civilised countries would call in the boy's parents and explain that such behaviour is unacceptable and send them to counselling.

    I'll have to say that I am offended by the way you put this, but I'll just assume that you are unfamiliar with proper doctor-patient interaction boundaries.

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