Hot Seat #141 Denouement: 15yoF with altered mental status.Posted on: December 13, 2019, by : Brian Lee
The case: This was a 15 year-old female presenting initially with altered mental status, which resolved with time, who had parents who wanted a workup she was refusing.
This post raised a fair amount of discussion, both related to a patient presenting with resolving altered mental status, and the role of adolescent autonomy. In terms of the medical management, before seeing and examining the patient, both fellows and attendings felt similarly about an initial workup. Once finding out the patient was back to her baseline, and did not personally want further workup, the polls were also similar, but the discussion revealed a bit of disagreement. Many felt that forgoing any workup was reasonable, whereas a few brought up concerns related to “what we might miss.” Ultimately, all agreed that respecting patient’s personal autonomy is paramount, and highlighted the importance of observation and frequent re-assessments.
In regards to the parental desires being at odds with the adolescent’s, respondents were generally united in respecting patient autonomy. During discussion, many reported lack of familiarity with legal statutes as they apply to patients who have capacity to make their own decisions, but are less than 18. Here are two resources that delve into these scenarios, both from the AAP: a general approach to testing, and as it may apply to school and home testing
Social work was consulted, spoke with the patient and family, and the patient was ultimately discharged home without further testing.
The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.
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