WBR0411

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::Genitourinary
Prompt	[[Prompt::A 16-year-old girl presents to the physician's office with fever and pelvic pain. Upon further questioning, she admits to a sexual history with multiple partners in the past 4 months. Following history-taking and physical examination, the patient is diagnosed with pelvic inflammatory disease (PID). The physician informs her that her condition is caused by her sexual activity and she requires antimicrobial therapy. She agrees to be treated, but she asks the physician that he does not tell her parents about her condition. Which of the following statements is the physician's most appropriate reply to this patient's request?]]
Answer A	AnswerA::“I cannot treat you, and I have to tell your parents”
Answer A Explanation	AnswerAExp::Parental consent is not required for the treatment of STI among minors.
Answer B	AnswerB::“I will treat you, but I have to tell your parents”
Answer B Explanation	[[AnswerBExp::Parental consent is not required for the treatment of STI among minors. The physician should not tell her parents if the patient does not wish to. Confidentiality may be broken only with the patient's permission or if the patient may cause self-harm or harm to others, which is not the case in this vignette.]]
Answer C	AnswerC::“I cannot treat you, but I will not tell your parents”
Answer C Explanation	AnswerCExp::Treatment of STI is necessary even without parental consent.
Answer D	AnswerD::“I will treat you, and I will not tell your parents”
Answer D Explanation	AnswerDExp::In the case of a minor presenting with STI, parental consent is not required.
Answer E	AnswerE::“I have to call the police”
Answer E Explanation	AnswerEExp::Police should be called when physicians suspect abuse or when patients may cause self-harm or harm to others, which is not the case in this vignette. Calling that police is thus not necessary.
Right Answer	RightAnswer::D
Explanation	[[Explanation::A minor is any individual under the age of 18 years. Generally, parental consent is required to treat minors. Parents may refuse the treatment of their minor children only when their refusal does not result in serious threat to the patient. If withholding treatment is dangerous to the patient and may result in adverse safety outcomes (e.g. life-threatening disease), the physician may initiate therapy on the basis of legal precedent. The physician may also treat minors without parental consent in the following cases: Life-threatening conditions and parents cannot be contacted: Consent for treatment is implied Emancipated minors (marriage or army) Any of the following diagnoses: pregnancy, sexually transmitted infections, drugs abuse, or alcohol abuse Educational Objective: A minor is any individual under the age of 18 years. Although parental consent is generally required to treat minors, minors presenting with STI and who do not wish to inform their parents may be treated without parental consent. References: First Aid 2014 page 59]]
Approved	Approved::No
Keyword	WBRKeyword::Sexually transmitted infections, WBRKeyword::Parental consent, WBRKeyword::Consent for treatment, WBRKeyword::Minor, WBRKeyword::Emancipated, WBRKeyword::Emancipation, WBRKeyword::Sexually transmitted disease
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