1. Case study Dr Iram Yasin

2. Miss LB 15 year old girl 15 year old girl No remarkable PMH No remarkable PMH Attends on 30/11/2011 with mum & sister Attends on 30/11/2011 with mum & sister Pregnant with 17 year old boyfriend Pregnant with 17 year old boyfriend Quiet Quiet Withdrawn Withdrawn Little eye contact Little eye contact Mum says …’ well tell her then..’ Mum says …’ well tell her then..’ Miss LB says ‘..erm.. I’m pregnant…’ Miss LB says ‘..erm.. I’m pregnant…’

3. What thoughts are going through your mind as the Dr? What thoughts are going through your mind as the Dr? What would be your next step ? What would be your next step ? How does the consultation feel.. How does the consultation feel..

4. Then… Mum and sister are most talkative during the consultation.. Mum and sister are most talkative during the consultation.. …sister had similar accident at the same age and had an abortion and both feel that LB should have the same …sister had similar accident at the same age and had an abortion and both feel that LB should have the same …LB states ….’they don’t know how I feel its my body and my baby…’ …LB states ….’they don’t know how I feel its my body and my baby…’ Mum tells ‘ boyfriend is not going to stick around, I cant afford to have her and another mouth to feed, and she only wants this baby cos’ all her friends have babies..’ Mum tells ‘ boyfriend is not going to stick around, I cant afford to have her and another mouth to feed, and she only wants this baby cos’ all her friends have babies..’ Sister …’ she doesn’t understand this is going to ruin her life…’ Sister …’ she doesn’t understand this is going to ruin her life…’

5. Any thoughts? What would you do next? What would you do next? Thoughts about the structure of the consultation? Thoughts about the structure of the consultation?

6. And then… Tried to engage eye contact with Miss LB Tried to engage eye contact with Miss LB Boyfriend aged 17, consensual sex, not forced or aggressive. Boyfriend aged 17, consensual sex, not forced or aggressive. Arranged follow up later that day with boyfriend and Miss LB alone Arranged follow up later that day with boyfriend and Miss LB alone Mum booked next appointment for herself..to talk about LB!! Mum booked next appointment for herself..to talk about LB!!

7. Alternative options ? Other management ideas ? Other management ideas Thoughts about Fraser competence Thoughts about Fraser competence Mums appointment?!?! Mums appointment?!?!

8. Appoinment with couple Miss LB more talkative, expresses that she understands she is young but would like to consider keeping the baby Miss LB more talkative, expresses that she understands she is young but would like to consider keeping the baby Boyfriend feels he is too young and cant cope with responsibility Boyfriend feels he is too young and cant cope with responsibility Refer to – teenage pregnancy specialist midwife! For balanced options counselling Refer to – teenage pregnancy specialist midwife! For balanced options counselling at Keighley Sexual health clinic

9. What happened next? Phone call from mum at AGH – Miss LB admitted for ? Ectopic, currently in theatre..’Could you ask them to get rid of baby at the same time!..’ Phone call from mum at AGH – Miss LB admitted for ? Ectopic, currently in theatre..’Could you ask them to get rid of baby at the same time!..’ d/w Obs SHO – made aware of situation d/w Obs SHO – made aware of situation TOP 7/12/2011 at AGH TOP 7/12/2011 at AGH

10. Post TOP Multiple attendances for UTI, abdo pain Multiple attendances for UTI, abdo pain Two further admissions to AGH for ? Appendicitis Two further admissions to AGH for ? Appendicitis Split with boyfriend, low mood, Marie Stopes post TOP counselling arranged Split with boyfriend, low mood, Marie Stopes post TOP counselling arranged

11. What did I learn? Complexities of consultations with imposing relatives. Complexities of consultations with imposing relatives. To try to maintain structure of consultation to allow focus on patient To try to maintain structure of consultation to allow focus on patient Fraser – Gillick competence and how to apply this Fraser – Gillick competence and how to apply this Use of MDT Use of MDT To be able to be truly non-judgemental (personal beliefs) To be able to be truly non-judgemental (personal beliefs)

12. Thankyou