Teenager Case Histories:
How Would You Handle These Cases?
1. Case One: A 16 year old girl, who has been your patient
all your life, comes in to your office complaining of early morning nausea.
She states that she couldn't be pregnant. You do a pregnancy test and it is
positive.
The patient begs you not to tell her parents. Her father will "kill" her
when he finds out. She just wants you to give her the name of someone who
will perform an abortion.
What do you do? Options:
- Comply with her wishes and give her the name of a gynecologist who
will perform the abortion.
- Try and persuade her to talk to her parents and have the parents and
the girl come in for an appointment.
- Refuse to grant her wishes, call her parents, and tell them what the
story is.
Discussion: Most of the time parents know when their teenage
daughter is pregnant or could be pregnant. Involving them in the
discussion, having the parents communicate with their daughter through you
is the most desirable option.
However, in most states a 16-year-old is an adult, and her advice must be
followed. If she insists on not telling her parents, she has the right to
do that. You must get her permission to get the parents involved.
2. Case Two: A 15 year old boy, your patient since birth,
has been a good student until this year when he started to have failing
grades. His parents told him to come in for a check-up to see if there is
anything physically wrong with the child. They noted that he has begun
smoking, growing his hair long, and wears only the color blacks.
Discussion: You must inform your patient that you are testing him
for drugs. When you find evidence of drugs in the urine test, you cannot
share those results with the parents without the child's permission. You
must, just as in the first case, try to solve the problem through the
patient. Even if the parents call you and demand the results, you must
first get the permission of the child.
3. Case Three: A 16 year old girl, your patient since
birth, comes in to your office for the first time in the last 6 months. You
are overwhelmed by the change in her appearance: she has lost 35 lbs. She
indicates that she feels fat and needs to lose more weight. She has been
exercising obsessively for the last four months.
Discussion: Anorexia is a potentially life-threatening illness.
Most teenagers will not be able to deal with this problem successfully
without the help of a trained therapist. Pediatricians cannot usually
succeed when they try to handle this sort of case. Again, however, you may
be asked to be involved.
4. Case Four: A 16 year old girl, your patient since birth,
admits during a routine physical exam that she is bulimic. She states that
she is doing well in school, has many friends (in fact, she learned this
"weight-reduction technique" from one of her friends), and plans to pursue a
degree in nursing.
What do you do? Options:
- Advise her against remaining bulimic
- Advise her to get counseling
- Advise her to examine what she is doing, determine that she will
control her intake, get on a good exercise program, and that she will
agree to see you twice a month until the condition goes away.
- Say nothing.
Discussion: Most bulimic adolescents are not eager to tell you
about their habit. While this condition, in no way, is as difficult to
treat as anorexia, you need expert help. One way to do that is to choose
option 3: have you be the contact person. Since the patient has been your
patient since birth, you have credibility. If you try and directly refer to
a counselor, many children will not keep those appointments.
5. Case Five: A 16 year old girl, your patient since birth,
comes in with the complaint of a persistent vaginal discharge. Your pelvic
exam shows her to be positive for both Chlamydia and for Gonococcus. She
admits to having had 5 partners this month; she can remember the name of
only 4 of them. She is not sure whether her partners used a condom. Once a
good student, she is now failing school, and doesn't get along with her
parents anymore.
Discussion: Once again, it is the job of the pediatrician to
oversee the entire care of this patient. Just treating the STDs, and
sending the girl home would not be all you should do. You must treat the
illness, and then make sure that proper counseling is obtained.
SUMMARY AND CONCLUSIONS:
The pediatrician can not be judgmental, or punitive in his or her
dealings with teenage patients. Whether the problem is pregnancy, anorexia,
bulimia, or STDs, the patient needs help. Help must be given medically, but
also needs to be given psychologically as well
Next Page |