A 15 year old male was brought in to the Family Clinic by his mom a couple of years ago.
He didn't really want to talk at first so mom started off by informing me that he had blood in the toilet bowl a few times. Mom was leading the conversation and it was her that made him come in and had also driven him.
The boy had had a few brief episodes of bright red rectal bleeding associated with rather bad pain and stinging on defecation over the last week. Inconsistent diet with recent constipation/hard stools. No red flags – no weight loss, no family history of cancer etc. Everything is pointing to an anal fissure/fissures
I performed a physical including an abdominal examination and all was well.
Then I discuss that I am very reassured but we should perform a rectal exam to be 100% sure. I informed him that I would get a nurse chaperone to be present and explained the procedure. The boy adamantly stated that he did not want this. Mom then chimed in that he needs to do it. I agreed with the boy that it was his right to refuse and explained again what the purpose of it was. The mom told him that the doctor wanted to do it and it was important so we can make sure there isn't anything more serious going on. Again the boy said "No." I then offered that I could do a quick visual inspection and that I may be able to confirm the fissure. Again this was flatly refused. Mom kept on pushing him to get it done, until eventually he quietly agreed and mom got up and left the room, closing the door behind her.
Once she was gone I asked the boy if he wanted to do it. He was a bit panicked and asked that we not do it, but tell his mom that we did do it to stop her pressuring him.
It took me a good few seconds to decide what to do…
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