In this scenario, I am a physician with a 14-year-old patient who wants birth control pills and does not want me to tell this to her parents. As a physician, my main concern here is the wellbeing and safety of my patient, the 14-year-old. First, I must gather more information. I would ensure my patient and I are in a private area and she does not feel rushed. I should sit down and ask her why she is interested in birth control. I can also find out what she knows about birth control, and if she has taken birth control pills or used other contraceptive methods in the past. I should also ask if she has any other medical issues. Importantly, I need to sensitively ask if she is sexually active and to ensure she is not being forced or coerced into anything. Based on the information she gives me, we can plan together. She could simply be curious and not be sexually active right now, in which case I would give her resources (ex. websites, pamphlets) to find out more information.
If she is planning on being sexually active and is consenting to this activity, and I feel she understand the risks and benefits, I would go ahead and prescribe the birth control for her. My concern is my patient, and prescribing the pills is important for her safety; however, I would address that birth control pills do not prevent STIs, and would give her the appropriate recommendations for preventing them. I would tell her that our conversations are confidential and I would not share anything with her parents without her consent. Physicians must judge whether a patient is a mature minor, and can consent to treatment without parental input. If I feel she is not able to consent as she does not understand the risks and benefits, I would let her know that I need to have a discussion with her and her parents present prior to prescribing the pills. If I feel that she is being abused or coerced into sexual activity, for example by a person over 18, I would need to report this to the appropriate authority. I would ensure to set a follow-up appointment in place with this patient prior to ending our visit. To summarize, I would ensure my patient’s safety and find out more from her prior to planning with her input for further steps. Thank you and I am happy to address any follow-up questions if you have them.