new_n_lost
Politically InCorrect
Topics: 654
Posts: 6,112
|
No Answer for this Plz Give Valid REason for UR choices Or Dont Bother At All
A 17-year-old high school student requests to see a psychiatrist for depression. She states that she does not want her parents to know about this.
From a legal and ethical point of view, which one of the following should the psychiatrist do?
1) Accept patient's request
2) Contact the patient's parents
3) Tell her she must bring her parents to the next session
4) Ask the patients general practitioner to inform the parents
5) Refuse to see her again without parental consent
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| keepgoing
Forum Guru
Topics: 71
Posts: 1,825
|
i think 5..b/c she is 17yo-->considered minor i.e <18yo
parental consent not required if..emergency case,if pregnant,if Rx contraceptive pills and if minor is alcohl dependent asking for help..
___________________
"God be with me "
|
| usmle4me
Forum Elite
Topics: 6
Posts: 283
|
Here we consider that the patient is staying with her parents and so is minor (age 17)and so best thing is B. inform or contact her parent.
But if she is not staying with her parents and staying independently and surviving on her own than in that case she is not consider minor and you neednot inform her parents or say her say matters.
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
parental concent is not required to treat a minor for
1. STD
2. prenatal care
3. contraception
4. HIV
5. substance abuse
A minor - person under age 18
parental concent is REQUIRED for ALL forms of treatment other than these with the exception of emergency.
Looks like only ans 5 fits.
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
in other words - same what keepgoing posted
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
minor theme
interesting point from Kaplan
"occasionally, a 17-y.o. child with leukemia that will likely to be fatal anyway is allowed to refuse a transfusion or chemotherapy.
a 17 y.o is close to legal adult, the disease is not sudden, and the treatment will likely not change outcome."
|
| new_n_lost
Politically InCorrect
Topics: 654
Posts: 6,112
|
3) Tell her she must bring her parents to the next session
I choose this choice forth e reason that She though a Minor is coming to the Doc for Depression. the Physician shud keep this mind the most suicides r commited in minors rather then adults n any pt with depression is more likely to commit suicide than a non- depressive one. This maybe her first n last try to get some help so rather to refuse treatment on the grounds that u cant treat her or be her confidante' i wud not close any opportunity where i cna establish a line of cmmunication n then later onwards ask her to bring her parents in.
Its Just Like the Condition where u treatthe pt without consent of parents
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| po
Forum Elite
Topics: 39
Posts: 356
|
agree,expln is good.
By the way is it nbme q?
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
i chose 3 ) .. same principle as for OCPs... we dont wanna see unwanted pregnancies so we rather give them OCPs and have 'em under control, and even offer 'em some education, instead of refusing to give 'em what they want...
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
and doctor prescribes meds
and kid takes whole bottle
and parents doing what?
(bcs doctor thinking about such possibilities like suicide)
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
why not 2 ?
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
no, bc you tell her to bring in the mommy  next session...you just dont wanna tell her " no, i want your parents right now and here, orelse i dont even look at you".. somehow you wanna have her under your eyes
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
Besides she is almost an ADULT...17y/o
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
parental concent and parents on the session - bit of difference.
|
| new_n_lost
Politically InCorrect
Topics: 654
Posts: 6,112
|
me007 wrote:
and doctor prescribes meds
and kid takes whole bottle
and parents doing what?
(bcs doctor thinking about such possibilities like suicide)
Dont u consider the possibility of Abuse/Neglect in a Child in that situation. Isnt it required by thte Doctor to call up child services to chk around if the history of abuse is present evn on the slight hint.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
5) refuse to her again...
- means somehow you've seen her, but for treatment minors legally you need parental concent
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
"5) Refuse to see her again without parental consent "--> i feel is bassically a refusal of treating her... it doesnt mean you have seen her before , this option clearly says " she comes to you , the MD, seeking for help, and you, (the MD) say NO... im not going to see you AGAIN unless i have parental CONSENT " thas my understanding goes as far as the option 5)... i feel the girl can falsify a signature of parents or something, besides that would not be enough, just a CONSENT... thas why i'd rather go have her IN and at the next session i ask her to BRING( means PHYSICAL PRESENCE ) of mommy whatever daddy IN
Edited by Luckyall on 05/02/07 - 10:44 PM
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
I still think that the answer should be 2. cos none of the other options make sense to me. I might be completely wrong. but this is what I think... 1) you can not just accept her request as she is under 18, 3)you dont want her parents in the next session you just want their consent and if you insist that she brings them with her the next time, she might not even turn up and she might be a danger to herself. So you can not afford to lose her. And in the qn they say that she asked you not to tell her parents. So if you insist she will definitely dont turn up in the next session. 4) in USMLE whatever it is you are supposed to do it yourself. So this option is ruled out. 5) you can not refuse treatment to your patients again she might be a danger to herself. 2) you are just contacting her parents for their consent and also that would alert the parents about their daughter and it might actually help you understand them as well, if they are really concerned they will definitely show up in the next session and you can as well rule out abuse or anything else at that point. But the qn asks you what you would do in the above situation, it does not give you any clue about abuse. As I said I might be completely wrong. But I think I would choose 2.
|
| new_n_lost
Politically InCorrect
Topics: 654
Posts: 6,112
|
Hypothetically speaking.......
Remember when we were teenagers n we used to literally hate and shun the person who used to 'rat us out'. we never trusted that person cos he didnt keep our secrets confidentialty issues we were kids at tht time but it was still important to us. Now imagine a 17 yr old girl who comes to u for help regarding depression U an MD a total Stranger. She says she is depressive but u dont know the cause behind it. Shud she be helped or Simply refused that she is a minor n we need her parents to get their consent. wht if the child was a from an absuive family a troubled time n the cause of the depression was a parent wht do we do. We in ER r supposed to call up the Social Services n Authorities on the slightest suspicion of abuse n the parents r investigated in every way possible.
We cant shun away youngsters just bcos we cant talk to them as their parents arent around them. Shudnt we as doctors educate the children abt depression n how harmful can it be for them not to open up.
ok i think i stop now cos i m way off the topic. 
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
nice speech both of you doc179 and new_n_lost !!!
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
|
| new_n_lost
Politically InCorrect
Topics: 654
Posts: 6,112
|
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
ok, guys, what is the ans?
3 - not bcs "next" session - we don't know about 1st one and "parents on the session" - does not sounds right
4 - just no
5 - no bcs "see her again" - again no information about 1st visit, and "refuse" sounds rude.
either 1 or 2 -?
2 - if she does not want them to know, and she is 17, apparently she will need psychiatrist in her future, doc does not respect her wish - not good.
the last one -1 -?
by the way, what is the source of the qustions without answers?
|
| new_n_lost
Politically InCorrect
Topics: 654
Posts: 6,112
|
FYI I posted a Disclaimer on the Start of the Question
Dont Know Found on other Forum a quite a long time back among many others which dont have any answers this is one of them.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| rock
Forum Elite
Topics: 23
Posts: 305
|
i agree with doc179...thats what i feel too...the girl is a minor and as per the law her parents have to be contacted because it is not an emergency(rule out suicide) and it is not one of the four exceptions.
well what would happen then is that the doc would talk to the girl and explain to her why her parents will be contacted(by every doc that she goes to) but that he will still make sure that she gets the best possible treatment...try to make the patient understand why it is best for her parents to be contacted...build a rapport with the patient...also ask the reason why her parents should not be contacted...or if there is a h/o of abuse...if there is then call child protection services right away...make her feel that you are trying to be of help to her in every way...
if she is suicidal then dont let her go out of the office...a doc a detain a patient for 48-72 hrs in most states in US...and then call the parents as well...
lots of things to ponder over...and lots of if's...but i go for 2.
there is no point in saying that she is almost an adult...either she is or she is not and the US has made the cut off point as 18 yrs...if she is 17 yrs and 364 days then she is a minor...and if she came to me the next day then i would not call her parents as she is now 18 and an adult!! its that point blank...
i would pick 2 with the limited info available from the question stem.
what if this patient is not living with her parents and is financially independent as well and is taking care of herself-accomodations+bills etc...well then she is an adult...then dont call her parents...so the question does not give enough info to be able to rule out all the if's...
|
|
| |
| | | | | | | | | | | | | | | | | | | | | | | | | |
