Doctor knows best
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In this consultation, we encounter a situation in which the doctor feels he knows what’s best for his patient but ultimately goes against his better judgment. At first, we see a student who last saw the doctor a few years ago due to being away at college. She brings a note from her student health service for the family doctor to read. The doctor opens it to find out that she has developed a possible TB lesion in her lung. She has been taking told to take the anti-TB drug Rifampicin. The student health service has stated that it’s nothing serious, and they are happy for her to keep taking Rifampicin to help.
Do they put everybody on the pill at college now?
After reading the note, the doctor asked, “Is your health good?” The patient replied yes, and the family doctor agreed to continue prescribing Rifampicin. However, the agreement was short-lived. When the patient requested a repeat prescription for Minalin, a contraceptive pill, the doctor’s attitude changed. The family doctor appeared shocked and asked, “Do they put everybody on the pill at college now?” The patient replied that not everyone is on the pill, but she believes it’s a good idea for her now that she has a regular boyfriend. However, the doctor disagreed with this idea.
During their conversation, the doctor expressed concerns about the use of contraceptive pills and the potential risks, highlighting that people tend to ignore the consequences of promiscuity and sexually transmitted infections. He mentioned the “grave dangers not only of the pill but of the consequences of what you people call sleeping around.” The doctor also pointed out that sexually transmitted infections are on the rise due to people “sleeping around”. On the other hand, he did not acknowledge that the patient was taking a mature and sensible attitude towards contraception. Instead, he asked if the patient had considered the consequences of her actions and expressed concern that relying on the contraceptive pill might lead to a false sense of security and potential health risks.
I'm not sleeping around.
Following that, the patient confidently informs the doctor that she is not involved with anyone else and does not suspect that she will contract a sexually transmitted infection (STI) because her boyfriend is also not involved with anyone else, and they are faithful to each other. However, the doctor is sceptical and does not believe this. He mentioned that he has been at the practice for a long time and has witnessed many different situations.
The doctor goes on to talk about how many people start on birth control and end up encountering various problems. He has known her long and has been her family doctor for quite some time, so he only makes these suggestions in her best interest. He says, “I wouldn’t like to see anything alarming happen to you!” The patient responds, stating that it would be more alarming to become pregnant as she then wouldn’t be able to finish her course.
Are you sure this is what you want?
With a strong sense of responsibility for his patient’s well-being, the doctor remains determined not to prescribe the Minalin Contraceptive pill. He asks again if she would reconsider and is sure this is what she wants. The patient mentioned she was already on it and needed a repeat prescription.
Finally, the doctor sighed and decided against his better judgment, emphasising that he was completely fine with giving her the prescription for Minalin, stating that she should think more about where her actions might take her. The patient agrees and makes a swift exit from the consultation.
The doctor camouflages his bullying and oppressive behaviour by claiming it’s in the patient’s best interest, citing that he’s been her family doctor for several years. Eventually, he consents to prescribe the Pill and Rifampicin, albeit reluctantly.
This trigger tape has proven to be highly valuable in assessing teachers. It contains numerous relevant teaching points, covering topics from the improper and insensitive treatment of patients by family doctors to a significant therapeutic mistake involving the contraceptive pill and the anti-TB drug Rifampicin, which can render the medication ineffective.