Question of the Week #25

•A 17-year-old girl comes to the office for a complete physical examination before going off to college. You have been the physician for her and her brother since birth, and for both her parents for the past 20 years. The patient has been very healthy and has had all of her immunizations. Her mother is always in the waiting room as you obtain the history and perform the physical examination. The patient admits to you that she has had her first sexual experience after the prom a few weeks ago. After she tells you this she becomes very worried that you will tell her mother. At this time you should • 

A. advise her to tell her mother herself so you will not have to tell her • 

B. explain that you will not bring up the issue but that you cannot lie if the mother specifically asks if her daughter is sexually active • 

 C. perform a pelvic examination and obtain a Pap smear specimen • 

D. tell the patient that your conversations with her will remain confidential • 

 E. try to convince her to talk about these issues with her mother •

20 Responses

  1. d

  2. C. perform a pelvic examination and obtain a Pap smear specimen •

  3. d

  4. d

  5. An annual Pap smear is recommended starting at age 18 or at the onset
    of sexual activity. After three normal Pap smears, the screening interval
    can be ↑ to every three years.

    C

  6. D

  7. D

  8. D
    PAP if 21 yo, or been having sex for 3 yrs

  9. D partial emancipation on pgcy issues

    but E–encourage to discuss with parents???

  10. dddddddd

  11. EE

  12. D,

  13. DDDDDDDDDDDDDDDD

  14. at this point establishing a good patient rapport is essential snd letting her know she can be honest and safe in a conversation with you is key . D is the answer
    let it be said that the health maintenance should be done but the rapport building takes priority …

  15. Pap smear should be done after 3 year of first sexual encounter or at the age of 21, which ever comes first.

    In every doctor patient communication, patient’s confidentiality and wishes should be respected, unless there is considerable harm to self or the other.

    • Pap smear is done at the age of 21 irrespective of sexual activity!

  16. D. tell the patient that your conversations with her will remain confidential •

  17. D. Regarding minors std,pregnancy are confidential until unless its threat to partner then encourage her to tell the partner.Again no need for parents consent for this and also physician should educate her on STD and need for contraception and safe sex techniques

  18. why not e?

  19. if pt becomes pregnant then what about confidentiality?
    what about decision of abortion?
    who has a rights ? daughter or mother?

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