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confusing ethics question !!!!!!!

4293 Views 4 Replies 4 Participants Last post by  Mondoshawan
A 14-year-old boy is brought to the physician by his mother because of a 3-month history of severe blemishes on his face and back that have been increasing in number. His mother has bought many over-the-counter medications for the acne, but he has not used any of them. Physical examination shows multiple pustules. Which of the following is the most appropriate next step?

A Ask the patient if he is concerned about the appearance of his skin

B Obtain a dietary history

Suggest a new nonprescription medication

Provide a prescription for a topical antibiotic

Recommend a consultation with a dermatologist

what is the answer plz ?
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That is confusing - because you would certainly do A, B and D! I guess the question is which you would do first, and so I would go with A as well: involving the patient in his own medical treatment is always a good idea, whether the patient is 4 years old or 40. It increases compliance with treatment and I would think probably allows us to get a better history from them.

We can exclude C because his mother has already tried many non-prescription medications, and "severe blemishes" could mean a cystic acne that will leave both physical and psychological scars if left untreated.

We can exclude E because we have not reached the limits of any generalist's scope of practice, and because of the "never refer on the USMLE" rule of thumb.
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...But then again, it is always ''what the patient wants'' ...
:) I'd like to change that maxim to: "It's never what the patient doesn't want," which seems a more accurate description of the autonomy of an adolescent patient...
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