Why Parents Should Skip the Waiting Room

Crimes committed against children are invariably horrifying. Crimes committed against children by their medical providers send my blood pressure into stroke-risk range.

Such is the case of Dr. Howard Schneider, a Florida pediatric dentist whose story seems drawn from one of Lemony Snicket’s fever dreams. As reported by CNN, Dr. Schneider is accused of extracting his patients’ teeth unnecessarily, and in some cases physically assaulting them. He is under investigation for fraudulently billing Medicaid, which apparently pays for procedures by the tooth, and is also facing a class-action lawsuit.

Hearing of the allegations against Dr. Schneider, however, one particular factor stood out to me as a pediatrician—in many of the cases in which abuse was said to occur, the parents were told to stay in the waiting room.

I had the same reaction to reading an installment of Slate’s Dear Prudence column a couple of years ago, in which a mother expressed suspicion that her own son’s dentist had sexually abused him under similar circumstances. (The dentist’s arrest for possession of child pornography years later cemented her suspicion, and triggered feelings of significant remorse). Then as now, I found myself wondering how parents and children end up separated in the first place.

According to Dr. Grant Ritchey, a Kansas City dentist, there is no standard approach to allowing parents to remain with their children during dental care. His impression is that dental generalists often have parents stay with their kids, while pediatric dentists may (counterintuitively) be more apt to have them stay in the waiting room.

“Parents often worsen behavior if they project their fears onto kids,” Dr. Ritchey told me of a common problem dentists face. I have no doubt it is a complicated dynamic to manage.

That being said, the idea of separating a patient from his or her parents is almost unfathomable to me except under very particular circumstances. It is simply something I would never do.

On occasion, when I step into an exam room I find a child waiting alone. Usually the parent has ducked out to use the restroom or to make a quick cellphone call. When that happens, I typically start chatting about some anodyne topic while we wait for mom or dad to come back. I always leave the door open until the parent returns. I do not confine myself with a young patient behind a closed door. Ever.

This ironclad policy changes as patients age. Once adolescence hits, my male patients often choose to have their parents stay in the waiting area while I do their exam. But I always ask what they prefer with the parents present, and if they don’t really care I default to having the parent stay. In the case of girls, I always have a female member of my staff in the room with me when I do the exam.

Am I doing this for the patient’s safety? Not really. Of course I know the children and teenagers who come to see me for care are perfectly safe, even if their parents aren’t right there. In my case, I have someone else in the room to reassure my patients of that safety, and for my own protection. The presence of another grown-up offers some indemnity against future accusations of impropriety.

The one circumstance in which I would choose to deliberately separate a child from his or her parents was one in which I suspected abuse. Getting a vulnerable patient away from someone inflicting harm on them is often a necessary step in getting them to safety, and medical providers must always be cognizant of the importance of recognizing those situations when such a separation is in order. But even then, I would be sure to have other personnel involved for everyone’s protection.

Putting the shoe on the other foot, I have a very difficult time imagining myself complying with an instruction to stay behind while one of my own children went for some kind of office procedure. Thus far, the (wonderful) pediatric dental practice we take our kids to has kept us with them during routine care. Their layout also offers lots of visibility through the use of open space and windows. Even so, if one of my kids needed a procedure done, I would want to be present.

I acknowledge the unique difficulty some patients or parents may present during dental care, about which many people are downright phobic. I also understand how the parents can add their own anxiety to their child’s, merely making matters worse. However, in such cases a clear protocol must be in place to assure parents and patients alike that there is no potential for abuse. The shocking allegations out of Florida demonstrate just how wrong things can go without one.