A teenaged patient presented with a complaint of severe headaches. Her medications included oral contraceptive pills. During the visit, I mentioned that birth-control pills could contribute to headaches. The girl seemed surprised and denied that she was “on birth control.” Her mother was with her in the office and became very angry that I used those words. She told her daughter that the pills were not contraceptives but hormones for her menstrual problems. By the end of the visit, the mother was calm but it was difficult to regain the patient’s trust. How would you handle such a conflict between provider and parent?—TAMI BLAND, MSN, CPNP, Knoxville, Tenn.
Although this was undoubtedly a stressful clinical encounter, it is probably good that the patient came away with a better understanding of her medication. Asking questions and providing medical explanations can be a useful part of any clinical encounter. Next time you find yourself in a similar situation, consider mentioning the name of the medication and ask the patient why she is taking it. Certainly, there are other clinical indications for birth-control pills, including menstrual problems or acne. You can explain the full range of indications, including contraception, so that the patient is informed.
My colleague Elizabeth Burke-Roberts, PNP, of Norwich Pediatric Group in Norwich, Conn., advises, “I would have apologized for my wording, as it was clearly upsetting. However, it might have been helpful to take a few minutes to explain that the medication was originally developed to prevent pregnancy. I would have stated that it was also discovered to alleviate menstrual symptoms, which is now a common use. Reassure the mother that the term ‘birth-control pills’ was not meant to indicate that her daughter was having sex, but rather a blanket term used for that type of hormonal medication.”
Always assure patients—especially teens—that their records are confidential. Many clinicians who treat teens see them separately from their parent or guardian at least for part of the visit (i.e., social history). Alternatively, consider speaking to the parent alone to see what her concerns are. She might benefit from a brainstorming session of how to talk to her teenage daughter about sex, reproduction, and her body.—Lisa Stern, APRN (146-18)