Can I talk to you privately?

Every once in a while a parent will tell the nurse that they want the child out of the room to discuss an issue with the doctor privately. This is usually something they perceive as a negative thing for the child to hear. Some of the most common concerns are about the child's weight or behaviors. Sometimes it relates to a change in the family dynamics, such as divorce or a parent having a significant illness.

Secrets should never be kept...

While I understand the parent's intentions, I find this to be disruptive and counter productive. As much as I try to find an excuse to have a child leave, it is usually obvious that the nurse keeps them out longer than needed.

If we have the child leave the room, he knows something is up. We are talking about him.

But not sharing with him.

What could possibly be so bad that we won't talk to him about it?

How do you feel when you suspect people are talking about you?

When people talk secretively it hurts.

And we should always live by example.

I teach kids from early on that there should be no secrets in families.

Why then should parents and doctors keep things from the child?

That doesn't mean kids need to know everything.

We all know that as adults that we do shield our kids from things.

Kids do not need to know our financial worries. We can teach them financial responsibility without increasing their anxieties.

They do not need the burden of knowing about extramarital affairs. If there are problems in a relationship, they will know there are problems, but they do not need to know details.

I don't think that kids need to know everything, but that doesn't mean that we should make it obvious that we're hiding something. Especially when it pertains to them.

What does the child know?

Any patient needs to know what the issues are so they can be addressed. This includes most kids.

My guess is most of these kids already know what the concerns are.

They may need help working on the concern or help adjusting to the home life situation.

If they are overweight, we need to talk about what they eat, how they exercise, and how they sleep.

When there are behavior problems, they need to give insight into how they feel and what leads to the behaviors.

Regardless of the issue, they need to be a part of the plan to fix the problems. If they aren't on board, they won't change their habits. I can talk about weight (or behavior, or drugs, or whatever the concern is) sensitively and in an age appropriate manner with the child. The kids at school are likely talking about it in a not-so-sensitive manner, so it's best to not make it worse by secretly discussing it.

What if it really needs to be said?

If a parent really wants to let a physician know specific points without the child present, there are ways to do that without making the child feel left out.

• Send in a letter or secure electronic message with your concerns before the appointment. Be sure it's at least a few days before the appointment so the doctor has a chance to review it!

• Schedule a consult appointment for just parents to come in without the child.

• Call in advance to note your concerns so the physician can address it as needed during the visit.

• Slip a note in with all the paperwork you're turning in during check in so the physician can read it before coming into the room. Be sure whoever you give it to realizes it's included with the standard paperwork so they can pass it on.

• Don't bring siblings to an appointment where you want to discuss a private matter with your child.

All of these help the physician know your concerns without blatantly kicking a child out to talk about something privately.

Your child will appreciate it.