If you were a doctor, what would you do with...

[ctan]

Lisa, a fifteen-year-old who recently moved to a different province, is being seen today for the first time by a new physician for a well-child check. He has not yet received her medical records from her former doctor.

In the exam room, she tells her new physician that she is healthy and takes no medications, only vitamins. She says she is an honors student, swims, and plays the violin. When the physician asks whether she is sexually active, she says no, but admits that she is thinking about it because she is in love with a boy from her old school. The two have been dating for a year and have recently started talking about having sex. The physician asks if they have talked about birth control, too. Lisa says they have and tells him that she started taking birth control pills a few months ago. The physician mentions the necessity of using a condom as well to guard against sexually transmitted diseases, but Lisa replies that they are both virgins, so neither has to worry about that.

Lisa's physician briefly leaves the room to let her get undressed for the exam. In the hallway, he sees Lisa's parents, who have accompanied her to the clinic. They say they must speak to him immediately and in confidence. He is surprised, but shows them to his office. There, they tell him that Lisa has congenital HIV and has been taking HIV medications that were prescribed by her former pediatrician. They also tell him that she does not know this—they have told her the medications are vitamins.

Without mentioning anything that Lisa told him in confidence, the physician tells her parents that he thinks it's time they told her she has HIV. Her parents get very angry. They insist that Lisa is still a child, and there is no reason to tell her yet. The physician mentions Lisa's boyfriend and the length of their relationship. He reminds them that Lisa's boyfriend will be at risk if he and Lisa have sexual contact.

Lisa's parents say they know all about her boyfriend, but they insist the relationship is not mature enough for them to be thinking about sex—all they do is play video games together. They adamantly disagree with the physician's view that Lisa is old enough to know her HIV status and say they will sue him if he tells her without their permission.

If you are the physician, what should you do?

[Peps]

hmm or I'll ask someone to talk to the boy's parents

[bukojob]

how can the parent sue the physician if he's just doing his job?

[ctan]

^^ buko, I am thinking because of the confidentiality issue about the case. Congetinal HIV would mean that the parents (or at least one of them) is/are HIV positive because the child got HIV from them. Thus, telling the situation to the boyfriend or even to the child without the parents' consent would violate the confidentiality clause. :-)

[bukojob]

but the patient of the doctor here is the child. at the very least, she must know what's happening. Besides, the doctor did take a vow regarding this... right? (di ko alam kung ano nasa vow pag lisensyado ka na e)

[marvinofthefaintsmile]

well... ctan should warn the bf instead..

[ctan]

hmm or I'll ask someone to talk to the boy's parents

pepsi, against patient confidentiality naman to. kelangan between doctor and patient lang yung info. :-)

[ctan]

but the patient of the doctor here is the child. at the very least, she must know what's happening. Besides, the doctor did take a vow regarding this... right? (di ko alam kung ano nasa vow pag lisensyado ka na e)

Hmmm.. Ako man, gusto ko rin sabihin sa bata ang condition niya. However, the child is just 15 years  old, still under the supervision of her parents. Hehehe.

[marvinofthefaintsmile]

from what i can see.. prang hinde nmn ata nanghihina ang bata.. So meaning.. hinde pa ganun ka-worse ang AIDS nya? Feel q kc eh pag me AIDS ka eh parang bed ridden ka na lang.. tapos skin and bones ka na lang.. So.. it is not always this case ba?

OT: In fairness, honest si gurl...

[hiei]

^^ buko, I am thinking because of the confidentiality issue about the case. Congetinal HIV would mean that the parents (or at least one of them) is/are HIV positive because the child got HIV from them. Thus, telling the situation to the boyfriend or even to the child without the parents' consent would violate the confidentiality clause. :-)

Yes its a direct violation of HIPPA if any health information is divulge to the boyfriend. The only loophole that you can take advantage of is a minor can get medical access even without parental consent if it is about mental and reproductive health. On this case, you can tell the girl as part of her wellness check to include hiv test which she can do it on her own.

If you think the girl is mature enough , further counseling regarding her situation will be legal sibce its part of her reproductive health and involvment of the.parents just make her situation worst. Btw asking advise with your malpractice lawyer will also help.

[ctan]

Good points there hiei. I was just thinking though. If the physician would suggest to the child that she undergo an HIV testing, it would be off-track for a well-child check. It's not routine kasi to request such for a child. By doing so, it is a suggestive act, an insinuation of something beyond what's supposed to be in a well-child check.

[hiei]

Good points there hiei. I was just thinking though. If the physician would suggest to the child that she undergo an HIV testing, it would be off-track for a well-child check. It's not routine kasi to request such for a child. By doing so, it is a suggestive act, an insinuation of something beyond what's supposed to be in a well-child check.

Yup you're right its not part of f wellness check. But thats the only thing i thought of on how to ask her to do the hiv testing. Btw i. Ask my wife abt your predicament, she said that she'll still tell the patient even if she's a minor that she has hiv. She said its her right to know and prevent herself from infecting her bf. Then i ask about the parents suing she said on what grounds? She said the argumentbof her being a minor and consent is needed is very weak esp the effect o such consequence is greater than 'protecting' their daughter from the truth.

[ctan]

That's right hiei. If I were the physician, I'd also inform the child of her condition especially that she is now in the stage where she begins to be more "explorative" of her body. Thanks for your input hiei!  :-)

[niceako]

hi ctan, i also agree with hiei, i'll also inform the child in the event that i'm the physician. it'll make her more responsible in her actions, and it can help shape her future.

[vortex]

wow gandang situational ask.
Siguro kung ako yung doctor i'd tell the child na rin of her situation, siguro in approach na lang that she can understand without getting intimidated of her sickness.Well it's a duty as a doctor naman to tell honestly to your patients yung findings mo sa check up sa kanila eh. Sa parents naman, mahirap makipagtalo kung stuck sila sa idea na bata pa ang anak nila, but I'd tell them the risk na pedeng mangyari sa bata, without scaring them to death!!!