No one likes unsolicited advice. It doesn’t matter if it’s good advice and it doesn’t matter if it’s well meant. Patients are no exception, even though part of the provider’s job is to counsel patients about their lifestyle choices. Smokers don’t want to be told not to smoke; overweight people don’t want to be told about the risks to their health.
That’s why I always tried to confine myself to the unadorned facts, and carefully excise any value judgments from my comments. Every now and then, though, I couldn’t help myself.
Any gynecologist is depressingly familiar with sexually active young teens and preteens, and the dreadful consequences. I often saw these girls in the Emergency Room in the middle of the night, unaccompanied or accompanied only by teenage friends. Certainly, no one came in with her mother. Perhaps that’s why I was not expecting a discussion of birth control when an affluent mother brought her 12 year old to the office for a consultation.
Improbably, the mother was beaming. Very few people are beaming at their gynecology appointment.
“We’re here for the Pill,” she announced cheerfully.
“The Pill,” I was shocked and it must have showed. “Who’s here for the Pill?”
The mother plowed ahead. “I brought my daughter to get the Pill. She’s sexually active.”
I turned to the daughter. She nodded her head slightly in affirmation.
“I’ve explained,” the mother continued, “that when you are sexually active, you always have to use protection, and the Pill is the best protection there is. That’s why I brought her myself.”
“Well,” I started tentatively, “the Pill is the best protection against pregnancy, but it doesn’t offer any protection against sexually transmitted diseases. Before we get to that, though, I’d like to talk a little more about sexual activity. I turned to the daughter again. “What grade are you in?”
“Seventh.”
“How old is your boyfriend and what grade is he in?”
“He’s 17 and he’s a senior in high school.”
“Yes,” the mother confirmed proudly, “she’s dating a senior.”
“Have you considered,” I ventured, “that might not be such a good thing?”
“What do you mean?” The mother was clearly annoyed.
“I mean,” I said, “that 5 years is a big age gap. There’s a big difference between a seventh grader and a high school senior.”
“So?”
“So, the needs and desires of a 17 year old boy are very different from the needs and desires of a seventh grader. A sexual relationship might seem like a good idea for a 17 year old, but it’s inevitably a bad idea for a 12 year old.”
“But she wants to date him,” the mother responded.
“Yes, she may want to date him, but that doesn’t mean that there might not be an element of coercion involved. Let’s think about this for a minute; what kind of 17 year old boy dates a 12 year old? It’s usually someone who has no success with girls his own age, and has to reach down to much younger children to have a sexual relationship.”
The mother was clearly growing angry. “But I thought you’d be impressed that I brought my daughter in for birth control,” she said, “My mother wouldn’t have done anything like this. She didn’t even tell me the facts about sex.”
“Sorry, I’m not impressed that you brought your sexually active 12 year old in for the Pill. I’m worried that someone is taking advantage of her.”
I kept looking in the direction of the daughter, but she made no response.
“We didn’t come here for your dating advice,” the mother replied heatedly. “Are you telling me that you won’t give her a prescription for the Pill?”
“No, that’s not what I’m saying. If her exam is normal, and she has no risk factors, I’m certainly going to give her a prescription. She’s sexually active and she needs to be protected from pregnancy. And I’m going to talk about condoms, too, since the Pill does not protect against sexually transmitted diseases.”
The mother was not mollified. She sat stonily through the rest of the interview and exam. When I finally wrote the prescription for birth control pills, she snatched it from my hand.
“Thank you,” she said coldly. “That’s what we came for. And by the way, the next time we want your opinion, we’ll ask for it.”
