Case Study: Patient Confidentiality and Teen Pregnancy
Yasmine Kamal is a 14-year-old high school student. She is being treated for major depressive disorder at an outpatient mental health facility. She currently sees a psychologist for weekly therapy sessions, but has made little progress. The psychologist refers her to the psychiatric nurse practitioner (NP) to determine whether antidepressant medication might be beneficial. The patient and her mother discuss the issue with the NP, and they all decide that a trial of a low-dose antidepressant is warranted. Prior to prescribing medication, the NP orders routine laboratory work according to the facility’s protocol, which includes a pregnancy test for any female of childbearing age. The laboratory results are all within normal limits, and the pregnancy test is positive. The law of the state in which the case occurred requires written permission from any patient age 14 years and older to discuss information with a parent. Yasmine has not signed the permission form. On the follow-up visit, the NP sees Yasmine alone and explains the results of her pregnancy test. Yasmine bursts into tears and begs the NP not to tell Mrs. Kamal, Yasmine’s mother. The Kamal family is of Egyptian descent and very active in their church. They believe it is important that a girl remain a virgin until marriage. Yasmine feels that she cannot face her parents, and that it was a one-time consensual sexual encounter with her boyfriend. She is ashamed and does not know what she wants to do. The NP calls in the psychologist and they discuss with Yasmine the pros and cons of Yasmine telling her mother about her pregnancy, but Yasmine still insists that she does not want her mother to know yet. The NP explains that she will not prescribe an antidepressant at this time, and that it is extremely important that Yasmine continue to see the psychologist to discuss her options, and to continue psychotherapy to treat her depression. Yasmine promises that she will keep seeing the psychologist. After determining that Yasmine is not in danger of harming herself, the NP and psychologist agree that she can leave after making an appointment to see her the following week. The NP and psychologist discuss the case and decide that they should meet with the facility’s medical director for further advice. The next day, there is a phone message for the NP from Mrs. Kamal inquiring why Yasmine did not get an antidepressant prescription….patient confidentiality……
Discussion Questions
- How did the NP and psychologist respect the patient’s confidentiality?
- Is discussion of the case with the medical director a breach of confidentiality? Why or why not?
- How can the NP and psychologist maintain a trusting relationship with both Yasmine Kamal and her mother without violating confidentiality?
- How should the NP respond, with honesty, to Mrs. Kamal’s question regarding why no antidepressant was prescribed?
- The NP and psychologist respected the patient’s confidentiality in several ways:
- They initially discussed the positive pregnancy test result with Yasmine privately, ensuring that her mother was not present during this conversation.
- They engaged in a discussion with Yasmine about whether to disclose the pregnancy to her mother, giving her the opportunity to express her wishes and concerns.
- They did not disclose the details of Yasmine’s pregnancy or her decision to withhold this information from her mother without her consent.
- Discussion of the case with the medical director is not a breach of confidentiality. In healthcare, it is common and ethically appropriate to consult with colleagues, supervisors, or medical directors for guidance and advice on complex cases. In this situation, seeking guidance from the medical director is a way to ensure that the best interests of the patient are being considered and that the healthcare providers are following the appropriate ethical and legal standards……patient confidentiality…….
- To maintain a trusting relationship with both Yasmine Kamal and her mother without violating confidentiality, the NP and psychologist can take the following steps:a. Continue to engage in open and honest communication with Yasmine: They should maintain a safe and nonjudgmental environment in which Yasmine feels comfortable discussing her concerns, fears, and options regarding her pregnancy and mental health.
b. Encourage Yasmine to involve her mother: While respecting Yasmine’s autonomy and right to make decisions about her healthcare, the healthcare providers can explore the possibility of involving her mother in a supportive and sensitive manner. They should explain the potential benefits of sharing this information with her mother while addressing Yasmine’s concerns.
c. Explore options for confidential support: The NP and psychologist can help Yasmine identify individuals or organizations, such as a counselor, social worker, or support group, that can provide her with guidance and support during this challenging time while maintaining confidentiality as needed.
d. Continue psychotherapy: It is essential for Yasmine’s mental health that she continues psychotherapy with the psychologist. They should ensure that Yasmine understands the importance of ongoing treatment and that her depression is addressed.
e. Document the interactions and decisions: Thoroughly document all discussions and decisions made in Yasmine’s medical record to maintain transparency and demonstrate adherence to ethical and legal standards…..patient confidentiality……
- When responding to Mrs. Kamal’s question regarding why no antidepressant was prescribed, the NP should do so with honesty and professionalism, while respecting Yasmine’s confidentiality. The NP can explain that they made a clinical decision not to prescribe the medication at this time and emphasize the importance of Yasmine continuing psychotherapy as part of her treatment plan. It is crucial not to disclose any specific details about the positive pregnancy test or Yasmine’s decision to withhold this information from her mother unless Yasmine provides explicit consent to share that information. The NP can also offer to discuss the decision further with Mrs. Kamal if she has questions or concerns about her daughter’s treatment.