ABORTION
female patient of 15 years, emergency consultation at the maternity clinic. Is carried by their parents who report accuses her daughter go because strong abdominal cramping pain in lower abdomen of two days duration, associated with genital bleeding. History of dysmenorrhea grade II to III, from menarche. Vital signs, BP 120/80, pulse 110 x min, FR 16 x min, T ° 37.5 ° C.
care In the box, out of sight of their parents, the patient reported that he had no periods since the summer holidays date on which they had sex with her boyfriend. Not been controlled by fear of their parents.
On examination the pregnant uterus is found approximately 2 ° month of pregnancy. The speculoscopy a gaping neck, by which POC out smelly, and regular blood in quantity.
· Question No. 1
or What is (the) assessment (s) more likely (s ) of the patient?
According to medical history and physical and gynecological examination of this patient are some diagnostics that we can easily dismiss such as a threatened abortion as this is defined as metrorrhagia with or without lower abdominal pain and cramping the speculoscopy is possible to observe a cervix with the OCI (internal os) closed, it is not the case of the patient with a dilated OIC, however it is not an inevitable abortion as this has no expulsion of POC as the patient if expulsion of POC may relate to incomplete abortion. could also suspicious of another diagnosis that is septic abortion, which has several diagnostic criteria such as: abortion, fever> 38 ° C
Once the patient is only asked the doctor who treats you that do not communicate the diagnosis to their parents. However they do require additional examinations and gynecologic ultrasound, for which should be hospitalized.
· Question 2
or What should the doctor do, What you see values \u200b\u200band principles that are in conflict?
The doctor before taking this decision that may be of great importance both as a medical-legal family, should reflect on the values \u200b\u200band principles at stake in this situation. First is the principle of autonomy , since the patient has specifically asked the doctor to be kept secret, but on the other side is opposed to the principle of beneficence , because if the patient is hospitalized properly treated can have serious health consequences, including septic shock and death. As we know medical confidentiality is a fundamental part of the doctor-patient relationship must always be respected, with some exceptions and one of them is that the patient can not make their own decisions, and that is because it is not competent to do so or not old enough to be accountable for its actions and decisions, in this case the patient may be fully aware of their actions and be capable of discernment, but it is legally a minor and medical decisions should be made by their legal representatives, in this case their parents. As we believe that physicians should talk to the patient, alone, explain what their health status, complications if not treated properly and timely and also talk about the medico-legal problems that can cause an abortion in our country, so that the patient can decide on their own to tell their parents, unless this situation believe that the doctor should inform parents of the child's diagnosis has come to, possible treatments, consequences and get their informed consent to hospitalize a patient and perform the necessary tests to confirm their status and treatment. Although as a group believe that if the doctor manages to establish a good relationship with the patient and manage to have adequate confidence, she will probably decide to tell your parents what happened and for that the doctor can help enough to face this situation.
· Question No. 3
or What would you say are the physician's obligations to ...?
a) With What rights do parents have? The physician has an obligation to inform parents the medical condition his daughter, possible treatment options and the risks involved with each procedure you perform. Since we believe that parents have the right to know "why" of the hospitalization of her daughter and we do not invent another appropriate diagnosis because parents with minor children are also part of the doctor-patient is more, they form a triad (Doctor-parent-patient) the physician must respect.
b) With patient What are your rights? The obligation the doctor treating the patient, not just the biomedical, but include it on the biopsychosocial model of modern medicine, which involves dealing effectively with much its medical expertise and professionalism, doing everything in their power to achieve health of the patient. But do not forget the psychological and social support is included in the emotional, empathy, education, social support.
c) With Duties of society "to an abortion doctor? In our country abortion is illegal, so the doctor should not allow or perform an abortion. In patients that you explicitly request that they do one, he must educate them about the abortion law and with great empathy solve doubts and fears that the patient may have about your pregnancy, to achieve greater acceptance of it. Given the situation described in a case the physician should report the situation, because if it does it could mean a penalty against him.
· Question No. 4
Discuss with your teacher this case and ask if you have a situation of confidentiality that is opposed to other principles. What have you done?
Commenting on this case with a teacher tells us that as the patient is a minor, the physician's duty is to give information to parents the diagnosis of her daughter, but that effort must first speak with the patient and adequately explain the situation and talk to her fears and concerns so that she can make the decision alone to tell their parents of their pregnancy and subsequent abortion, we note that in most cases the patient agrees to talk to their parents, but with the help of a doctor.
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