*3.5. Patient–Provider Relationship*

Many participants described the health center's medical staff as rude and not attending to patients, specifically pointing to the perceived lack of professionalism of the staff. Bart (age 13, male) offered his own experience as an example: " ... when a (female) doctor is there and you say, 'oh my, that doctor is going to be there', and you go and they see you and say, 'I'm busy' and she isn't busy and is actually on her phone and like, what? She's not busy? (Cuando está una doctora y dices 'chin, va a estar esa doctora', y vas y te atiende y dice 'estoy ocupada' y en realidad está en el celular y ah, ¿cómo? ¿No está ocupada?)". Gordito (age 14, male) sarcastically expressed his perspective of the doctor's attitudes: "Let's see if the doctor is not tired and wants to see you (A ver si el doctor no esta cansado y te quiere atender)." Rosita (female, age 13) mirrored this sentiment, expressing that she believed doctors at the health center "sometimes they do it with a bad attitude (A veces hasta con mala gana)." Aside from not attending to the patients, some students suggested the doctors were incompetent because they would not prescribe the correct medication, or because they would give shots incorrectly or in a way that hurt patients. Regardless of the accuracy of such statements, it is important to note how the doctors' professionalism and competence were perceived by youth in the community.

A follow-up question seeking additional information about the challenges youth faced while speaking with the doctors led to a broad range of response including being scared of the doctor, not trusting the doctor, and simply not wanting to talk to the doctor. Several youth directly stated they were afraid of the doctor: "It scares me (me da miedo)" (Mayte, age 12, female); "I am afraid of the doctors (A mi me dan miedo los doctores)" (Victoria, age 12, female). Others stated that they do not talk openly with the doctors "because I do not trust them (Porque no les tengo confianza)" (Komander, age 13). The distrust theme was especially pervasive among female students, who were uncomfortable with male doctors. The female moderator summarized a conversation among the girls in one focus group: "Ah, yeah. There is no trust because they are doctors and in the case of the women [female youth], they are always hoping for a female doctor (Ah, ya. Que no hay confianza porque son doctores y en el caso de las mueres siempres buscan como una doctora)." Kalel (age 14, male) brought up how being scared and uncomfortable at the health center affected his communication with the doctor, stating, "we are really nervous, so we do not understand much (Estamos tan nerviosos que no entendemos mucho)."

When asked about their level of comfort speaking with adults, including doctors, about their health, the most common response was that it was difficult because they were embarrassed: "I am embarrassed with doctors (Me da verguenza con los doctores)" (Natalia, age 12, female); " . . . we ge<sup>t</sup> embarrassed (Que nos da pena)" (Lena, age 14, female); "we even ge<sup>t</sup> embarrassed to answer [their questions] (Hasta nos da verguenza contester)" (Gordito, age 14, male). For both males and females, the embarrassment many times stemmed from discussions of sexual health. Axel (age 13, male) explained "for example, sometimes your intimate [private] part hurts and you do not want to tell the doctor so they don't check it (Por ejemplo. A veces te duele tu parte íntima y no le quiere decir al doctor para que no te la revise)," while Victoria (age 12, female) suggested that she was embarrassed because "they ask you ... if you have had sexual relations (Igual te pregunta si has tenido relaciones sexuales)." Both male and female students expressed that having a doctor of the opposite sex contributed to their embarrassment. Aureli (age 16, male) commented "if a female doctor is chosen you ge<sup>t</sup> nervous (luego si te toca un ... una doctora, te dan como nervios)," while Natalia (age 12, female) recounted her experience with a male doctor, "you feel a lot of embarrassment because, um, they tell you 'raise your blouse a little bit so I can check your stomach,' and you say like ... ay ... thinking 'oh, no, how embarrassing' (sientes como mucha pena porque, este, te dice: 'Alzate la blusa tantito para checar tu estómago', y te quedas como . . . ay . . . pensando 'ay, no, que verguenza.'"
