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PUID: 51 || PLAB 2 Mock 2 :: Confidentiality With Family1: Underage Contraception Mother

Summary:

This case involves a consultation with a concerned mother who discovered contraceptive pills in her teenage daughter’s belongings and is distressed due to cultural and religious implications, as well as fears about safety and consent. The doctor must navigate legal confidentiality, safeguarding principles, and parental concerns while upholding professional and ethical standards.



Key Points:


Confidentiality

  • Do not disclose any confidential medical information about the child without her consent.

  • Clearly explain the legal boundaries regarding access to the daughter's medical records.

  • Reassure the mother that confidentiality would only be breached if there's a safeguarding concern (e.g., coercion or abuse).


Safeguarding and Gillick Competence

  • Assess whether the child was competent and gave informed consent.

  • Discuss the Fraser Guidelines, which assess:

    • Understanding of advice

    • Inability to be persuaded to inform parents

    • Likelihood of sexual activity regardless

    • Risk to health without contraception

    • Best interest in receiving contraception

  • Inform the mother that safeguarding assessments are standard and involve checks for coercion or abuse.


Ethical and Legal Considerations

  • Adolescent sexual health rights are protected by law if the individual is Gillick competent.

  • Confidentiality is maintained unless safety is at risk.

  • Duty to respect young patient’s autonomy and best interests.


Important Considerations:

  • Do not identify the prescribing doctor.

  • Do not reveal medical history without the child’s consent.

  • Avoid judgemental language; show understanding of the mother’s cultural and emotional concerns.

  • Address misconceptions: contraceptive provision is a safety measure, not an encouragement.

  • Use simple language to explain medical and legal processes.


Diagnostic Approach:

  1. Confirm the identity of the mother and clarify the relationship to the child.

  2. Verify understanding of the pills’ ownership.

  3. Ask if the mother has spoken to the child and explore her concerns.

  4. Explore safeguarding issues indirectly through the mother’s narrative.

  5. Consider contextual signs of abuse or coercion if mentioned.


Management:

  • Legal Clarification: Explain confidentiality laws and exceptions.

  • Reassurance: Emphasize routine safeguarding checks and consent assessments.

  • Communication Facilitation:

    • Offer to speak to the prescribing doctor to encourage the child to involve the mother.

    • Encourage the mother to find someone the child may trust.

  • Safety Netting: Explain red flags to watch for (e.g., withdrawal, bruises, behavioral changes).

  • Follow-Up: Offer to arrange future consultations involving the daughter, with her consent.

  • Information Provision: Offer leaflets on contraception, safeguarding, and parental involvement.


Communication Skills:

  • Use open-ended questions initially (e.g., "Can you tell me more about what happened?").

  • Validate emotions: “I can understand how distressing this must be for you.”

  • Avoid medical jargon; speak plainly and empathetically.

  • Allow the parent space to express frustrations and concerns.

  • Reaffirm the GP's role in supporting both the mother and the child.


Ethical Considerations:

  • Respect for patient autonomy and confidentiality.

  • Balancing parental concern with adolescent rights.

  • Promoting trust in the healthcare system by upholding standards of care and confidentiality.


Additional Resources:

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