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Sample MMI Interview Scenario Question with Expert Response

Prompt: A 15-year-old patient arrives at the clinic to request birth control pills from you. She asks you not to tell her parents. What would you do?

Expert response: In this scenario, I am a physician at a health clinic when a 15-year-old young girl steps into the exam room to request birth control pills. She states explicitly that she doesn’t want me to tell her parents. My main concern here is that I need to understand what the patient’s motivation is for requesting birth controls so I can confer with her in a productive manner and keep her safe and informed. I need to remain non-judgmental and avoid projecting my own prejudices onto the patient. While it’s important that I acknowledge my patient’s age, I need to use that information to think critically about how I can help the patient navigate their sexual health.

First, I will need to learn more about the patient’s situation. At this point, all I know is that she wants a birth control prescription and that she is 15. I know that the health care system in most states affords children, defined as those below the age of 18, complete control over their own health care decisions unless they lack the mental capacity. I will ask the patient if she is sexually active. It isn’t fair to assume that she’s asking for birth control pills because she is sexually active; there are many other reasons why she might be asking, such as heavy periods, that are just as common and valid. I will monitor my tone so that I sound compassionate so I can build trust and rapport, as she might be apprehensive or embarrassed if I fail to make her feel comfortable.

Not breaching confidentiality is embodied in the word. Violations involve disclosing private information without authorization. Other factors to consider are the two relevant ethical pillars, beneficence and non-maleficence. If the patient is of sound mind, then I have to entrust that she is capable of making her own decisions for her health. As such, I will verbally agree to not tell the patient’s parents, as this would violate the aforementioned ethical principles. After having the patient answer a few open-ended questions regarding her reason for wanting a prescription, I will want to discuss resources for sexual health. It would be imperative that she’s aware of the availability of contraceptives, sexual consent, and potential complications that can arise if precautions aren’t taken: pregnancy, sexually-transmitted disease, injury, and others.

Adolescents who are worried about confidentiality represent a complex barrier to accessing health services. When the patient enters the clinic, I will be supportive and agree not to tell her parents. I will ask her questions about why she wants to start a birth control prescription, and then depending on her answer, talk to her about sexual health, the different types of birth control methods, potential side effects, and benefits. In any case, I will direct her to some online resources that she can explore at her own discretion. If she isn’t requesting birth control for sexual health reasons, I will explore other potential ways of addressing whatever her concerns are, so she has options. Finally, I will emphasize that if she has any other questions, she can call the clinic so we can discuss her concerns.

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