NBME form 2 - Taking Consent before pelvic examination - USMLE Forums
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Old 01-06-2011
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Medicolegal and Ethics NBME form 2 - Taking Consent before pelvic examination

A 15-year-old girl is brought to the emergency department by her 20-year-old sister because of a 1-week history of fatigue, nausea, and abdominal pain. Menarche was at the age of 12 years, and her last menstrual period was 3 weeks ago. She has not had vaginal discharge. She is sexually active, and she and her partner use condoms inconsistently. Her temperature is 37 C (98.6 F), blood pressure is 110/60 mm Hg, and pulse is 95/min. Abdominal examination shows mild bilateral lower quadrant tenderness. Before a pelvic examination and a pregnancy test can be performed in this patient, consent must be obtained from which of the following?

A) The court

B) The patient

C) The patient's parent

D) The patient's sister

E) No consent is necessary

Please explain you answer. Thanks.
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Old 01-06-2011
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What do you guys think? should doctor take the consent from the patient!!!
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Old 01-07-2011
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Default I'd choose B

I would go with B) The patient

E) would only be correct if the patient were unconscious or delirious and harm might come to the patient if care were withheld - this would certainly never be true of a routine exam.
D) would only ever be correct if the patient's sister had legal guardianship or was legally empowered to make medical decisions for her sister.
A) The court can compel patients to receive medical care in the case of outbreaks, but you would only have to secure consent for treatment if the patient was a ward of the court (i.e. the parents had been disempowered or the child is in a juvenile detention center).
C) would be correct in many cases - it is the default rule that minors cannot consent to their own medical care; however, the exceptions to this are in an emergency, for the treatment of STD's (in most states), victims of abuse or neglect (in most states), in pregnancy (in many states), or if the patient is an emancipated minor or married. In this case, there is no reason to think that there is an emergency, so one would think that C would be correct... except for the possibly reproductive nature of the complaint. The problem is that we don't have enough information, really.

I would choose B). At 15, you would need the patient's consent for something like a pelvic exam even if you had the parent's consent. A minor is allowed to consent to reproductive health, excluding abortion, in most states, without parental permission. And, if the patient believes herself to be pregnant, that is enough in many states to consent to care.
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The above post was thanked by:
aktorque (01-07-2011)



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