Case Study: 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.
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?
- How did the NP and psychologist respect the patient’s confidentiality?
- The NP and psychologist respected Yasmine’s confidentiality by not disclosing her pregnancy to her mother without Yasmine’s consent. They also ensured that Yasmine’s medical information was kept confidential within the healthcare team. The NP saw Yasmine alone to discuss her pregnancy results and respected her wish not to inform her mother at that time.
- Is discussion of the case with the medical director a breach of confidentiality? Why or why not?
- Discussing the case with the medical director is not necessarily a breach of confidentiality. Healthcare providers often engage in discussions with colleagues or supervisors about complex cases to seek guidance and ensure that they are providing the best care possible. However, it is essential to maintain Yasmine’s confidentiality during these discussions by not disclosing her identity or any personally identifiable information.
- How can the NP and psychologist maintain a trusting relationship with both Yasmine Kamal and her mother without violating confidentiality?
- To maintain a trusting relationship with both Yasmine and her mother, the healthcare team can consider the following steps: a. Continue to have open and honest communication with Yasmine, respecting her autonomy and decisions. b. Encourage Yasmine to discuss her pregnancy with her mother when she feels ready or to consider involving a trusted adult, such as a family member or a counselor, if she is not comfortable discussing it with her mother directly. c. Emphasize the importance of Yasmine’s ongoing psychotherapy and support her in making informed decisions about her pregnancy and her mental health. d. Offer resources for Yasmine to explore her options regarding the pregnancy, such as counseling services, reproductive health clinics, and support groups. e. Maintain strict confidentiality within the healthcare team and ensure that Yasmine’s information is not shared without her consent, except in cases where there is a risk to her safety.
- How should the NP respond, with honesty, to Mrs. Kamal’s question regarding why no antidepressant was prescribed?
- The NP should respond to Mrs. Kamal’s inquiry with honesty, while also respecting Yasmine’s confidentiality. The NP can explain that they did not prescribe an antidepressant at this time because they believed it was important for Yasmine to continue her psychotherapy and address her depression in a comprehensive manner. The NP can emphasize their commitment to providing the best care for Yasmine and suggest that they would be happy to discuss the treatment plan further with Mrs. Kamal in a way that respects Yasmine’s wishes and privacy. However, they should not disclose Yasmine’s pregnancy without her consent, as it is a confidential medical matter.