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A 16 year old is about to have a p/v exam the father insists on staying with her daughter
a)ask consent from daughter?
b)draw a curtain in the examination room for the father to stay behind
c)ask father to wait outside
d)allow father as daughter is a minor
Interesting situation. I chose the option C
Question is incomplete. what the girl says is also important. Every patient either minor or adult has this right to be examined in private. If the girl agress with the presence of her father, no problem. But if the girl does not agree, we should politely ask the father to stay outside.
I'm pretty sure the question is incomplete as Hidehiran said. I also totally agree with him^.
Of note, if the indication was pregnancy or STD related (even Contraceptive advice), a 16 year old can come unaccompanied by parents (Patrial vs Fully emancipated Minor): Pelvic Exams count ie. 16 year olds can give consent on them unaccompanied. Either way, it might be best here to ask the patient first here as with regard to her privacy, she should have a good understanding of the procedure etc.
B and C are pretty blunt and will be whats considered the generally wrong answer in ethics questions.
D. is the question that makes you question what you know. ie Patient is 16 so who's in charge.... Again, what I would consider important in the stem is the indication for the visit but for the most part Pelvic Exams in USMLE are gyne related. Let the patient get what's comfortable for her.
Themes: Ethics of minors, Consent, OnG
Hope this helped
t answer is C.
agreed: question incomplete... BUT... don't you think to ask what she wants in front of a father wanting to stay is pressuring the daughter to say "yes" even if it's "no"?
you ask the father to leave.
as the girl from age 12 gets the right to decide for herself.
the father needs to be politely asked to stand outside the exam room
i think c is the best answer!
I agree with Chris868's analysis, the girl should be asked first (A) and explain to her that it's only an examination as well as the reason for each maneuver (localize the source of pain, palpate any masses, see sources of bleeding, size of uterus, etc). The father might be suspicious of the physician possibly over-cautious that during the exam the child would inappropriately touched. Whatever the findings for the maneuvers still the parent might not have an clear insight on what's going on so the parent might not necessarily invade the child's confidentiality by being present. If the parent insists on staying but the child refuses, the parent should be asked whether he'd feel comfortable if a nurse is present instead of him during the exam. Very tough question, easy to choose any answer.
definitely C, because if a pelvic exam is needed then there has to be something wrong going on...maybe she is getting molested by the father and he knows his presence will intimidate her from saying anything OR she may be sexually active in which case as THE patient, she should be made comfortable enough in order to disclose the details of her encounter/sex life.
personally, i would ask the parent to wait outside while i ask her again if she wants him in the room or not.
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