Meet Rage, a 17-year-old girl living on the streets of San Francisco who survives by "turning tricks" and living with her friends in abandoned buildings. She comes into clinic complaining that "it hurts when I pee." She ran away from home about a year ago and complains of stomach pains because her last meal at McDonald's was 2 days ago. She wants meds and she wants to leave.
Last week, we interviewed Rage for our Foundations of Patient Care (FPC) class. In FPC, we interview "standardized patients" (highly trained actresses) to practice our communication skills in difficult situations. For med year 2, the FPC gods threw us into the fire quickly, and we learned how to sensitively build a sexual history and watched videotaped scenarios involving personal issues. For example, how should a family doctor behave when his male patient asks for a Viagra prescription in order to have an affair (and his wife is also a patient of the doctor's)? Is the doctor "enabling" the husband to possibly acquire an STD which may endanger his wife's health? Is the doctor allowed to refuse writing a prescription on moral grounds?
Interviewing teenagers is a tricky task, my classmate and I had to convince Rage last week to stay for an hour and attempted to elicit a full medical and sexual history. She refused to talk about why she ran away, constantly distracted herself, and shot back questions (Q: "Are you sexually active?" A: "Are YOU?"). We finally convinced Rage that it was in her best interest to answer our questions so that we could give her the correct medication, explained why we needed a urine and blood sample (for UTI's, pregnancy test, HIV test, STD testing, and a regular CBC). Then we had to explain why we needed to do a pelvic exam. Luckily, she "consented" and we received our "lab results" on a sheet of paper after she left the room. Sometimes, these Problem Based Learning (PBL) cases are eerily similar to those "Choose Your Own Adventure" games that you play when you're a kid.
Rage's tests revealed that she is HIV+, and today's FPC involved a different set of students breaking the news to her during a second clinic visit.