Interview question (abortion)

[DatInterviewDood]

A pregnant 15-year-old unmarried teenager comes into your office asking for an abortion. What would you do? Would you inform her parents?

First I would communicate with the patient, understand her concerns, and reason for requesting an abortion. After listening, I would also bring up alternate options such as keeping the child or adoption.

After discussing with the patient, her requests come first. At this point I am unsure if I should include my pro-life or pro-choice POV?

Depending on the state, parental consent may or may not be needed for an abortion. So following the state guidelines in line with if the patient wants her parents to know is what I would follow.

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[Petrichor1]

They are underage, their guardian will be needed to sign off on the procedure. Atleast, that's what I thought is true in the US? I mean people can't even drink until age 21, how can they have the procedure so young without adult consent. I'm just interested in the answer because I don't know how true my statement is.

 

[gyngyn]

They are underage, their guardian will be needed to sign off on the procedure. Atleast, that's what I thought is true in the US? I mean people can't even drink until age 21, how can they have the procedure so young without adult consent. I'm just interested in the answer because I don't know how true my statement is.

In CA, underage patients can give consent to: prevention of pregnancy (and other sexually transmitted diseases/conditions), treatment of pregnancy-related conditions (including abortion) and prenatal care without parental consent. Other state laws do vary.

 

[Petrichor1]

In CA, underage patients can give consent to: prevention of pregnancy (and other sexually transmitted conditions), treatment of pregnancy-related conditions (including abortion) and prenatal care without parental consent. Other state laws do vary.

interesting. Though I'd think Cali to be the most liberal in these matters anyways.

The first thing that would come to mind for me as a physician would be the health repercussions of the woman after the abortion. http://americanpregnancy.org/unplanned-pregnancy/abortion-side-effects/
Being that this patient is so young, I would fear of any complications that might prevent childbirth afterwards. Maybe try to see what her upbringing was like and the potential pressures being put on her such as restrictive parents (though in these circumstances, any parent would not be happy). I'd like to know how adaptable the parent(s) are to the news and whether or not the patient is demanding the procedure through preconceived notions of what people in her life would want her to do rather than their actual reaction.

Grey's Anatomy scenario comes to mind (yes seriously). The way they demonstrate how the physician handles family drama is very useful but not everytime do you have a parent barging into the ED wanting to see their child and providing the opportunity for the patient to open up about the issue face-to-face with the physician nearby.

 

[gyngyn]

interesting. Though I'd think Cali to be the most liberal in these matters anyways.

The first thing that would come to mind for me as a physician would be the health repercussions of the woman after the abortion.

There are far fewer health risks associated with early elective abortion than undesired term pregnancy.

 

[kraskadva]

...
The first thing that would come to mind for me as a physician would be the health repercussions of the woman after the abortion. http://americanpregnancy.org/unplanned-pregnancy/abortion-side-effects/
Being that this patient is so young, I would fear of any complications that might prevent childbirth afterwards. ...

That website is fear-mongering, and seems pretty anti-abortion biased. There are very, very few risks of health repercussions for a woman getting a legal, physician supervised, medical or surgical abortion in the US. Certainly fewer health repercussions for a 15 year old, both immediately and long term, than giving birth.
For some actual, cited, facts: https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

A question like this in an interview is probably far more geared toward finding out your capacity for sensitivity to the patient's immediate and long term needs, regardless of your personal views, as well as a sensitivity to legal issues and parents legal/social rights.

 

[theonlytycrane]

Is a more direct pro-life / pro-choice question something that can come up? I.e. Would you give an abortion?

 

[gyngyn]

Is a more direct pro-life / pro-choice question something that can come up? I.e. Would you give an abortion?

This is not going to come up as an interview question.

 

[kavorca]

In some states, a minor who is pregnant by law makes her own health decisions. One doesn't need the parents to sign off on anything.

I think this is the law in Texas.

 

[QueenAudrey]

First I would communicate with the patient, understand her concerns, and reason for requesting an abortion.

Is this medically necessary? (I'm not an applicant this cycle but) Personally I would not interrogate someone on her motives behind an abortion. I don't want her to have to...oh, say, prove that she was raped or feel like she needs to relive anything or justify herself. I would make sure that she understands the health risks/benefits of pregnancy vs termination, plus any other options (adoption). There may be other requirements depending on the state, but ultimately I would respect her decision. I wouldn't want to come across as some judge she needs to petition for an abortion...@gyngyn? Thoughts?

 

[hamstergang]

Maybe try to see what her upbringing was like and the potential pressures being put on her such as restrictive parents (though in these circumstances, any parent would not be happy). I'd like to know how adaptable the parent(s) are to the news and whether or not the patient is demanding the procedure through preconceived notions of what people in her life would want her to do rather than their actual reaction.

You educate the patient so she can make the most informed consent possible, but otherwise none of what you wrote here matters. There's really no need to bring her upbringing into this, especially in an interview where that will make you seem judgemental or unfocused.

 

[LizzyM]

Is this medically necessary? (I'm not an applicant this cycle but) Personally I would not interrogate someone on her motives behind an abortion.

You might want additional information to determine if you need to report child abuse... for example if the "partner" is her teacher, pastor or father.

 

[QueenAudrey]

You might want additional information to determine if you need to report child abuse... for example if the "partner" is her teacher, pastor or father.

Ah, that makes sense. Thanks @LizzyM!

 

[Naruhodo]

For me it boils down to one word: Nondirective. Your POV doesn't matter. Theirs does.

But yes, if you suspect child abuse you must report. A little known fact is that some forms of genetic testing (like SNP microarray) detect stretches of homozygosity that can indicate incest. You might get 2-3% loss of heterozygosity if parents come from the same small town/village but if you see more than 10-12% you are basically required to report it.

 

[Med Ed]

You might want additional information to determine if you need to report child abuse... for example if the "partner" is her teacher, pastor, father, or conservative congressional representative.

FTFY.

 

[f4reignbeauty]

This is not going to come up as an interview question.

I actually had an interview question that was like this.

 

[wizzed101]

I think whoever quizzed you on this wedge issue was an ass and thus, cheesing is perfectly acceptable.

First, regardless of your opinion on abortion, you have to say that it is against your belief and refuse to perform the procedure. You cannot be legally or ethically forced to do something against your belief. Doing this effectively punts the second question. Of course, you have to mention that you will try to find her (or him- if the pregnant teenager had a penis- say this out loud) a doctor, and make arrangement to avoid incurring undue burdens. Now, since the interviewer was an ass, they will try to press you on answering the second question. And the only way they can do that while their mind is clouded by anger is to change the scenario into one in which the teenager was in critical condition and had to abort the baby. This is a no-brainer because you had not choice and modern religious doctrine would allow such life saving practice. But now you have to inform the parents/guardians regardless.

Last but not least, look the interviewer in the eyes, smile smugly and say "Your welcome."

 

[QueenAudrey]

Of course, you have to mention that you will try to find her (or him- if the pregnant teenager had a penis- say this out loud) a doctor

Good point. I was just reading about that somewhere....ah, yes: Elinor Burkett's "What Makes a Woman?"

http://nyti.ms/1RT51V0

 

[futuremdforme]

There are far fewer health risks associated with early elective abortion than undesired term pregnancy.

I'm always shocked how people don't realize how physically challenging and dangerous pregnancy is! And the risk of maternal mortality in the US is embarrassingly high.

 

[Member314159]

I wouldn't answer the question directly. The reason we go to medical school is to learn through courses, clinical experience, and mentorship the answer to these and other ethical questions. In fact, our answers will probably change throughout our careers.

I like the part about educating the patient and developing a trusting relationship. If it happened to me early in my career, I'd talk to mentors and maybe bring it to an ethics committee. If I'm uncomfortable providing the patient with the care or level of privacy she feels is necessary, I would try to refer her to a provider or organization whose policies are more in line with her requests.

Now, if we're in a rural setting where providers are few and far between; that would be something particularly important to consider when discussing the pt with the ethics committee because not giving a desperate patient a nearby, viable alternative may lead to self-harm.

I really don't know and pretending that I did in an interview would be BS.

 

[RogueBanana]

They are underage, their guardian will be needed to sign off on the procedure. Atleast, that's what I thought is true in the US? I mean people can't even drink until age 21, how can they have the procedure so young without adult consent. I'm just interested in the answer because I don't know how true my statement is.

Funny thing is, drinkin & drugs are pretty much all we regulate. The day I turned 18 I could (legally) walk to a gun store, buy 4 rifles/shotguns (after they did a quick felon/not a felon records check) and walk home with them in broad daylight. No permit, no registration, nothing. On a more related note, most of the "blue" states have laws in place to protect minor's rights to abortions, and the general social trend seems to be supporting more pro-choice options.

As far as the OP's question:
Don't be afraid to say "I Don't Know". It will reflect positively on you if you can admit you aren't perfect and are willing to learn rather than give a BS answer. Other than maintaining standards of care and determining if abuse is at hand; building a confidential and beneficent doctor-patient relationship is your only true duty. Advise the girl as best you can, refer her to other specialists who may be better suited to help if necessary, and ensure her safety and privacy above all else.

 

[gyngyn]

I actually had an interview question that was like this.

I apologize for whomever asked you this in an interview.