Medical Ethics: Minor with STI

Mock examiner feedback from the mock conducted on 24/06/24

Key Points

• Recognize the Nature of the Case:

• Identify early that the patient is a minor (15 years old) with a sexually transmitted infection (STI).

• Understand this scenario is not a standard history-taking station but involves sensitive issues such as sexual abuse and power dynamics.

Data Gathering

• Initial Questions:

• Ask about the number and pain of swellings in the genital area.

• Quickly identify the type of STI based on symptoms (e.g., single painful sore, multiple painful sores, etc.).

• Sensitive Information:

• Investigate the patient's sexual history briefly but effectively.

• Ask about the age gap and the nature of the relationship discreetly but directly.

• Check if the patient is being forced into the relationship or if there are elements of abuse or blackmail.

• Importance of Key Issues:

• Focus on understanding the main issue: the abusive nature of the relationship.

• Ask about the patient's support system and if anyone is aware of her relationship.

Management

• Transition to Management:

• Move to management promptly after sufficient data gathering, especially upon hearing the two-minute bell.

• Address the relationship and abuse before discussing the STI treatment.

• Key Management Points:

• Safety netting: Provide information on warning signs and what to do in case of worsening symptoms.

• Follow-up: Arrange a follow-up with a senior or specialist.

• Involve senior staff: Always mention involving a senior, particularly in cases involving minors and legal issues.

• Leaflets and pamphlets: Provide informational materials about STIs, safe sex, and support resources.

• Specific Actions:

• Reassure the patient and explain the need for protected sex to prevent further infections.

• Discuss the importance of a Pap smear, even if the patient is young and sexually active.

• Emphasize the legal implications of the relationship and the necessity of informing a guardian or involving child protective services if needed.

Interpersonal Skills

• Reassurance and Support:

• Offer emotional support and reassurance throughout the consultation.

• Be non-judgmental and open, encouraging the patient to share sensitive information.

• Confidentiality:

• Maintain the patient's confidentiality while gently probing into her support system and the awareness of her situation among her close ones.

• Handling Sensitive Topics:

• Tactfully handle discussions about the abusive relationship and ensure the patient understands the importance of addressing it.

Practice and Time Management

• Developing an Internal Clock:

• Practice timed scenarios to develop an internal sense of timing.

• Aim to complete data gathering within four minutes to allow ample time for management.

• Efficient Questioning:

• Prioritize key questions that directly impact diagnosis and management.

• Avoid dwelling on less critical aspects once the main issues are identified.

Additional Tips

• Always Involve a Senior:

• In scenarios involving minors, abuse, or legal issues, always mention involving a senior, regardless of the situation.

• Legal and Ethical Considerations:

• Understand and apply GMC guidelines regarding minors, sexual activity, and abuse.

• Ensure the patient knows her rights and the importance of safe practices and legal protection.

• Continuous Practice:

• Regularly practice with a timer to improve efficiency and accuracy in both data gathering and management phases.

• Reflect on each practice session to identify areas for improvement and adjust accordingly.