16 year old girl, came to you on the first occasion to obtain emergency contraception. On second occasion, she request for OCP and told you that she would not like her parents to know about her taking the pills. 2 days later, the mother came with the empty packs of OCP which she found in the dustbin. She was agitated and wanted to know what her daughter was given. How would you respond? Give reasons to support your response.
This is a short case that came out in Part II, 2008. Shoot now and see how close you get to the target. It is beTTer to make mistakes now. Interactive exercise is essential for part II. Those going for part I should also start preparing for part II because you are only given 2 to 3 months after the Part I to prepare for Part II. Bear in mind that confidentially is another favourite post-grad topic, it can come out in KFP or Single Best Answer!
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3 comments:
As far as I know the issue of confidentiality is of utmost importance except if patient is suicidal,homicidal and another reason i've forgotten.So if her mother wants to know we should address the issue of confidentiality and not discuss about it until permission is granted from the patient herself.However general issues could be discussed and allay her mother's anger.so how many marks do i get?
I think there is an age limit where the parents has full responsibility over the child, beyond that the child will be respected as an adult and fully responsible for herself. So, below that age, I think should be 18 years old, the mother has the right to know all about the child's well being and the practitioner has the responsibility to reveal whatever he/she knows to her, tactfully and hopefully to get her to understand the problem of her daughter. If the child was not having autonomy under the law and she is still under the legal care of the adult, in the first place the practitioner should not have been provided her with the OCP and and agreed with her request not to let her parents know about it. Counselling should have been taken place in the early consultation.
Since things already happened, which I would not let it happen in the first place, I just have to answer as below:
1. To calm down the mother first
2. To ask the mother to tell whatever she knows about the problem of her daughter
3. To guide her to understand the problem of her daughter.(problem with the teenager)
4. To tell her about the problem of getting pregnant
5. To advise her to discuss the problem with the daughter, and not to confront with her.
I will not reveal anything learn from the girl, but merely using the information obtained from the mother to form the basis of consultation and advise. I think by doing this, I have not breached the issue of confidentiality.
Rozimah,
Your answer is very good. The 3rd exception is physical or sexual abuse. Encourage the mother to discuss with her daughter about her own finding.
Song,
Age is a factor to consider when you are talking about consent for sex or immunisation. As for confidentiality, age is not a factor. The issue of confidentiality like what Rozimah mentioned is of utmost importance as it relates to doctor-patient relationship and ultimate effectiveness of our function as a doctor. If the patient lose trust in us, we will not be able to function effectively as his/her personal doctor. Bear in mind that although legal age is a factor in consent giving, you have to also consider them legally qualified if they display intellectual capacity to do so. Also remember that children who refuse vaccinations consented to by their parent/legal guardian should have their wishes respected and the parent/guardian informed.
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