Case study Dr Iram Yasin
Miss LB • 15 year old girl • No remarkable PMH • Attends on 30/11/2011 with mum & sister • Pregnant with 17 year old boyfriend • Quiet • Withdrawn • Little eye contact • Mum says …’ well tell her then..’ • Miss LB says ‘..erm.. I’m pregnant…’
What thoughts are going through your mind as the Dr? • What would be your next step ? • How does the consultation feel ..
Then… • Mum and sister are most talkative during the consultation.. • …sister had similar accident at the same age and had an abortion and both feel that LB should have the same • …LB states ….’they don’t know how I feel its my body and my baby…’ • Mum tells ‘ boyfriend is not going to stick around, I cant afford to have her and another mouth to feed, and she only wants this baby cos’ all her friends have babies..’ • Sister …’ she doesn’t understand this is going to ruin her life…’
Any thoughts? • What would you do next? • Thoughts about the structure of the consultation?
And then… • Tried to engage eye contact with Miss LB • Boyfriend aged 17, consensual sex, not forced or aggressive. • Arranged follow up later that day with boyfriend and Miss LB alone • Mum booked next appointment for herself ..to talk about LB!!
? Other management ideas Thoughts about Fraser competence Mums appointment?!?! Alternative options
Appoinment with couple • Miss LB more talkative, expresses that she understands she is young but would like to consider keeping the baby • Boyfriend feels he is too young and cant cope with responsibility • Refer to – teenage pregnancy specialist midwife! For balanced options counselling at Keighley Sexual health clinic
What happened next? • Phone call from mum at AGH – Miss LB admitted for ? Ectopic, currently in theatre ..’Could you ask them to get rid of baby at the same time!..’ • d/w Obs SHO – made aware of situation • TOP 7/12/2011 at AGH
Post TOP • Multiple attendances for UTI, abdo pain • Two further admissions to AGH for ? Appendicitis • Split with boyfriend, low mood, Marie Stopes post TOP counselling arranged
What did I learn? • Complexities of consultations with imposing relatives. • To try to maintain structure of consultation to allow focus on patient • Fraser – Gillick competence and how to apply this • Use of MDT • To be able to be truly non-judgemental (personal beliefs)