Judging Sexual Activity in a 15-year old
Sensitive enquiry as to the nature of the relationship
The GP gets the mechanical aspects of the consultation right here, but doesn't sensitively handle the approach to exploring the nature of the sexual relationship, which is identified between the 15-year old patient and an older young man in her class, no older than 16. According to current UK law, this is below the age of consent, but how this is communicated in EHC consultations matters in gaining her confidence to return for longer term contraception, according to Fraser test guidance, and whether the GP is seen as a trusted professional for sexual health advice of if she did start to feel coerced or unsafe in the relationship- a feeling that her consultations will be kept confidential as fas as possible will be key to earning her trust.
SCA Feedback Statements
Respect and or sensitivity shown to the person was inadequate or inappropriate
The examiner felt that you failed to treat the patient with sufficient respect or sensitivity. This may involve a sufficient introduction, consent where needed or assurance of privacy or confidentiality. Being sensitive to the patient involves noticing distress and responding sensitively. Or approaching emotionally charged areas carefully and/or seeking permission before proceeding to explore areas that are difficult or intrusive for the patient.
For consultations with children or patients with cognitive impairment, respect can be shown by engaging with the patient rather than entirely relying on their carer.
Insufficient respect may include excessive familiarity with the patient, dismissive body language and/or patronising behaviour.
Suggestions
You can check that you are being respectful by sharing your consultations with experienced colleagues in the practice. Ask whether you are being sufficiently respectful/sensitive to the patient? Notice the times when sensitivity is more challenging, perhaps when you are under time pressure or for certain patient groups.
Watch others consult and notice times when they are being sensitive and times when they could be more so.
The management plan relating to prescribing of medication was inappropriate or not reflective of current practice
You are expected to show that your clinical management skills are in line with current UK best practice, making safe prescribing decisions, considering relevant drug interactions, dosing, and side effects. You may not have developed a plan at all, where a prescription was needed. You may have prescribed or failed to stop an inappropriate medication; or issued an incorrect dose. Or you may have prescribed when no prescription was necessary in this case.
This may also refer to the suggestion of over the counter (non-prescription) medication. For example, perhaps tamsulosin rather than finasteride would have been more suitable for a gentleman with LUTS, first line. Or when prescribing alendronic acid, advice about side effects and how to take should have been given, enhancing patient safety.
Suggestions
Your management plan should be coherent and feasible. You should be familiar with current national guidelines such as those published by NICE (National Institute of Clinical Excellence) and SIGN (Scottish Intercollegiate Guidelines Network).
Make a habit of referring to prescribing guidelines and/or the BNF after you have seen each patient at work. Where appropriate, consider other options before prescribing and be aware of the risks of polypharmacy and the need to deprescribe, too.
Get involved with the work of repeat prescribing in your surgery, complete your Prescribing Assessment for WPBA. Attend prescribing meetings at work with your team and community pharmacist.