Who you are:
You are an FY2 in GP surgery.Who the patient is:
24-year old India Reid, made an urgent appointment to see you. She has mild learning disability.What you must do:
Talk to the patient and address her concern.
Data Gathering
Introduction
Hello, I’m Dr…, one of the junior doctors in this GP surgery.
Q: Can you confirm your full name & age for me please?
Q: Is it ok to call you “India”?
Q: Well, I understand that you have some concerns. Can you tell me about it? (Offer confidentiality if needed)
P: I am here to request a morning after pill. I had unprotected sex last night with my partner.
Q: I am here to give all the support you need, India. Before we go ahead, can I ask you a few more questions?
Q: Is it the first time you had unprotected sex? P: Yes
Q: Is there any reason?
P : My partner didn’t like it
Q: Explore menstrual history P: LMP 2 weeks ago.
Q: Explore sexual history and partner
Q: Has he ever forced you to do any sexual activities that you don’t want to?
P: No
Q: Explore learning disability
Q: Assess knowledge: Do you know the result of having unprotected sex? Do you know what pregnancy is?
Q: Q: Have you ever used the morning after pill before?
Q: Any regular contraception?
P: No
P : No
P 2
Q: Have you ever been pregnant before?
Q: Do you have any significant medical condition?
DESA
MAFTOSA ( Explore support system)
ICE
Examination
I would like to take your vital signs and do general physical examination and abdominal examination.
Management
- Offer screening for STI screening if the patient usually has unprotected sex.
- Offer morning after pill (use simple language, checking understanding)
- Need to take once only (Levonelle)
- If you vomit within 2 hours, you might need to take another dose as soon as possible.
- Advice to avoid sexual intercourse until next period
- SE: headache, nausea, vomiting, tummy pain
- Discuss long term contraception, safe sex practice
- Safety net
- Given written plan
- SE of EC pill
- Missed period
- Leaflet