You are an FY2 in GP
Personal Details:
Name: Sarah Jenkins
Age: 15
Medical Record:
Past medical history: None.
Regular medication: None.
Allergies: None known.
Notes:
A 15-year-old girl has come in requesting emergency contraception after having unprotected sex last night.
Task:
1. Assess her eligibility for emergency contraception using the Fraser guidelines.
2. Address her concerns
3. Discuss the management plan
Opening Sentence: “Hi… um… I think I need the morning-after pill.”
Open History (to give freely): “I had sex with my boyfriend last night, and we didn’t use a condom. I’m really scared I might get pregnant.”
ICE (Ideas, Concerns, Expectations):
Ideas: “I’ve heard about a pill you can take the morning after, but I don’t know much about it.”
Concerns: “Will you tell my parents? I’m so scared they’ll find out. They would kill me.”
Expectation: “I just want the pill so I don’t get pregnant.”
How to Act: You are very nervous, shy, and scared. You are fidgeting and avoiding eye contact. Your main concern is your parents finding out.
More History (only if asked): Your last menstrual period (LMP) was two weeks ago. Your cycle is usually regular. You and your boyfriend are the same age and have been together for a few months. You usually use condoms, but you just got carried away last night and didn’t have one. You understand the risks of pregnancy and STIs. You are certain you do not want to be pregnant. This was consensual sex, and your boyfriend knows you are here.
Social History: You are a student. You live with your parents. You feel you cannot talk to them about this.
Questions to ask:
“Are you going to tell my parents?”
“How does the pill work?”
“Are there any side effects?”
Establishing Confidentiality & Assessing Competence (Fraser Guidelines):
Thank you for coming to talk to me. I want to start by saying that everything we discuss is confidential, and unless someone comes to harm, we don’t disclose any medical records.
Can you tell me what’s on your mind?
To make sure I’m doing the right thing for you, I need to ask a few questions to understand how you’re thinking about this situation.
Can you tell me in your own words what you understand about the risks of unprotected sex? What do you think might happen if you didn’t take any action today? Have you thought about talking to your parents? What makes you not want to tell them?
Clinical History for Emergency Contraception: You mentioned the condom split. When exactly did this happen? (Date and time are important). When was the first day of your last menstrual period? Are your periods usually regular? Are you taking any other medications?
Safeguarding Assessment: “It’s important I ask this of everyone in your situation. Was the sex you had consensual? Did you feel safe? Is your boyfriend your age?
ICE (Ideas, Concerns, Expectations): What have you heard about the morning-after pill? Your main worry is your parents finding out and getting pregnant. Is there anything else you’re concerned about?
You’ve asked for the pill. Is this what you were hoping for from today?”
Reassure and acknowledge
Thank you for coming in and trusting me with this, Sarah. It takes a lot of courage. You’ve done exactly the right thing by coming here today. We can certainly help you. The ‘morning-after pill’ is what we call emergency contraception, and it’s used to prevent pregnancy after unprotected sex.
Addressing and answering the patient’s ICE:
Your biggest worry is about your parents finding out. I want to reassure you that everything we discuss here is completely confidential. As you are 15, as long as I am happy that you understand the situation and the decision you are making, and that you are not at risk of harm, I do not have to tell your parents. From our conversation, it is clear to me that you understand the situation very well, so you do not need to worry about me contacting them.
Next Steps:
There are a couple of options for emergency contraception.
1. The most effective is having a copper coil fitted. This prevents ova from being implanted in the womb and stops you from becoming pregnant.
2. The other method is to take the morning-after pill. Because it has been less than 72 hours since you had sex, I can give you a pill called Levonorgestrel today. It works by stopping or delaying the release of an egg. I can give you the tablet to take here in the clinic.
Your last period was two weeks ago, so the pill may not be effective if the ovulation has already happened.
The emergency pill can sometimes make you feel a bit sick, and very rarely, if you were to vomit within three hours of taking it, you would need to come back for another dose. Your next period might be a little earlier or later than usual, which is normal. However, if it’s more than a week late or much lighter than usual, you should do a pregnancy test.
General safe sex advice and long-term management:
It’s great that you usually use condoms. They are good because they protect against both pregnancy and sexually transmitted infections (STIs). Have you ever thought about using a more regular form of contraception, like the daily pill or an implant? That way, you have better protection against pregnancy, and you can still use condoms to protect against STIs.
We can book another appointment to discuss those options if you like.”
Provide absolute clarity and reassurance regarding confidentiality, as this is the main barrier to the consultation. Explain options for emergency contraception and how it works.
If the patient agrees to the IUD, then book her to have it done in the surgery in the same day. Otherwise, prescribe Levonorgestrel. Provide clear safety netting advice (vomiting, late period). Offer future contraception counselling and STI screening.
What is scenario testing? This case is a classic test of a candidate’s understanding and application of the Fraser guidelines for treating under-16s. It assesses the ability to create a confidential and safe environment, perform a structured assessment of competence, and provide patient-centred care that includes not just the immediate problem but also future health promotion (contraception and STI screening).