A patient aged 14 years who had had terminated a pregnancy presented, and was feisty about not wanting or needing contraception. The discussion batted back and forth, exploring what she wanted, why the pregnancy happened, and how she saw her future panning out.

She didn’t make a decision that visit, but I asked her to think about her choices and to come back. She did come back and asked to see “that old male nurse.” We had another frank and honest discussion, and she challenged me asking why I even bothered and stating it was her life to do as she wanted.

My reply was, “I would like to think you might get enough time to make your own choices and to do all the things you want and might need to do before you become a mother. You are your own person, and with reliable contraception you will get some space to make choices.”

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We talked about relationships, respect, and how it is easy to get an STD. The patient decided to have a contraceptive implant fitted, she completed an STD screen, and said she was going to speak to her young aunt about what had been happening. The patient said she was not prepared to tell her mother, because the family was in the middle of a messy divorce.

I saw her one more time. The patient said she had stopped the casual sex with the boys at school and had made some plans. It’s been three years now since then, and I do hope she has made some of her goals.

Being honest and authentic with patients is the key to working with them. Use skills such as motivational interviewing to ascertain what they want, because sometimes the patient just needs to hear their own story out loud.