Monday, January 17, 2011

2-fer


Sometimes you pick up a chart and you see that you are getting to see more than one patient. Usually a parent will bring in both kids to be checked out, etc. The most I ever had was 14. This was from a shelter that literally dropped off a van of people who had been exposed to scabies.

Last week we had a mom and daughter combo. The mother was in for "std exposure." She found out her boyfriend had Chlamydia and Herpes, so she wanted to be checked out.

She brought her daughter, who was TWELVE YEARS OLD, with her so she could get Plan B. Plan B is the "abortion drug," meaning the twelve year old was already sexually active.

We referred mom to county health and daughter to the local pharmacy (you don't need a script for Plan B) and planned parenthood.

What a 2-fer. Like mother like daughter I guess.

-ER Doc

25 comments:

Andrea said...

What. The. Fizz???

For the love of pete, PLAN B IS NOT THE ABORTION DRUG.

Plan B, aka the Morning After Pill, will prevent implantation of a fertilized egg, when taken within 72 hours of intercourse. If an egg has already implanted and pregnancy established, Plan B will not disrupt it.

The abortion drug is usually a combo of mifepristone (aka RU-486) and misoprostol. These drugs are NOT available over the counter!

I thought you were an MD. Get your facts straight!

SMT said...

As Andrea said, Plan B is not an abortion drug! Get your facts straight! It's because of comments like yours that young women still have trouble obtaining it even though it is legal.

Ms. E said...

Are you sure you're a doctor? Plan B is not the abortion drug. It's a high level dose of estrogen. Jesus.

And your judgment is ridiculous. Since you don't need a prescription for Plan B, but you DO need a prescription for birth control, maybe you could have written a script for that you jackass.

Anonymous said...

I'm pretty sure in my state plan B is only available over the counter if you are 18 or older. I could be wrong as I have never had to buy it and I am over the age of 18 so I guess it wouldn't concern me anyway.

Anonymous said...

There is something so wrong with that 2-fer.

Too bad you couldn't get her hotlined for abuse...and probably needed a 2-fer on the chlamydia screen, too.

Lurkette said...

A sexually active 12 year old? Isn't that a referral to social work (if not CPS) rather than Planned Parenthood? Did she have an exam?

So sad... A little girl who's stopped being a little girl. Surely there must be some neglect or abuse issues there. Or at least some seriously unskilled parenting.

StorytellERdoc said...

Two-fer, three-fer, four-fer...on and on and on. Words that strike fear in all of us in the ER! LOL

Sad commentary, though, about the mother and daughter. These encounters are becoming much more common...

Good post.

Mandy said...

Sounds to me like that little girl probably should have had an STD check. Sad as it sounds, her most likely partner is the mom's boyfriend.

I usually love this blog, but this post was really sad and judgmental. The vast majority of sexually active 12-year-olds did not make the choice to have sex, they are being raped or molested. Not to mention the fact that you're assuming the mom's a slut and training her daughter to be one and that's why they're there - it's much more likely that the boyfriend was cheating and picked up the STDs, plus he was molesting the daughter. It's cause for a CPS investigation and compassion, not disgust and judgment.

Anonymous said...

Plan B misinformation AND slut-shaming. A two-fer indeed.

SerenityNowHospital said...

Omg u people can be ridiculous.

It was very mutual sex between her and another 12 year old. I didn't go over all the details but she had an appropriate work up.

And so sorry in my sleep deprived state I advisemently wrote abortion pill instead of morning after pill. Maybe it's because tons of conservatives freaked out upon it's release and call it an abortion pill. I don't care either way bc I am pro abortion and pro plan B.

But gese why get so worked up. Are ur lives that small?

And to call me a jack ass bc of it ms e? Please. Maybe ur a dumb wainch bc no ER physician would ever prescribe birth control pills, especially to a freaking 12 year old.

And yes this blog is judgmental. Duh

It's readers like this that make me not want to put in the effort to write this shit down. But never again will I blog after a night shift bc I realize it's been a few days since a previous post.

ER Doc

ERP said...

Dude, your hospital is the ghetto-est ghetto-y place ever. The PERFECT place for blog material!

Anonymous said...

Mandy it's funny how u outcry about being judgmental when ur comment is all assumtions and judgements

Anonymous said...

Yeah, just for the record. Plan B is not FDA approved for young ladies under the age of 17 (Making it a Federal level restriction, not state-based). Its a b.s. approval restriction (no basis in reality or physiology) but in this case it would make 12yo ineligible for OTC Plan B. Gotta write a script if you wanna give it to her.

Anonymous said...

We are all judgmental. Cuts both ways. I love your blog and sorry you are tired but you know if you are going to write not everyone is going to like it. And some of you will call you on it.
Being from a state that it is difficult to get Plan B, I can understand some readers frustration and anger when the term abortion pill is used. This is the term that has made it possible for some pharmacies to refuse to carry it on "moral" grounds and so far it has been upheld in my state. But they are talking about cutting millions from low income family planning programs to balance our budget. Short sighted *sigh*

Anonymous said...

It's just retarded to let such a little thing bother u so much

Sara said...

Actually, if you believe life begins at conception, plan B is an abortion drug because it prevents implantation, therefore killing the days-old life. That means all forms of birth control that interfere with implantation are abortion drugs.

Regardless, the mother and daughter need some serious counseling!!

Ms. E said...

I wish I could understand your insult, but I fear it wasn't written in the English language.

I'd say insinuating that a minor child is a whore is unprofessional- even if you admit your blog is judgmental. There's no room for that.

And if you're truly a doctor, then you must must must understand the positions on the topic before you make such inflammatory statements. There is no such thing as "pro-abortion", only pro-choice.

Anonymous said...

20 bucks says ms e is a lesbian

minimedic said...

*sigh* I think I might be the only conservative, pro-life person who did NOT flip out the "abortion" drug reference...and yeah, I am one of those people who believes life begins at conception...so I take hormonal birth control that prevents the release of an egg.

For instance notice the use of qoutation marks around the word abortion...I took this to mean "laypeople tend to view it as a type of abortion drug."

For those of you who thought the 12-year old should have been given a script for birth control, I'm gonna bring up a few points of concern here, then I shall crawl back to my little ambulance driver cave.

1.) 12 years old? Sounds like she either just began or is still in the early stages of puberty. I'm only a paramedic, mind you, but I would not be comfortable giving a 12-year-old hormones that will be interfering with the hormonal changes that her body should or will be undergoing over the next few years.

2.) A perscription for birth control should NEVER be written lightly, as "the pill" has certian risks and should not be given to smokers or those with high blood pressure, etc, and even if it is taken, said patient needs to remain under a primary care physcian (and not the ED doc's) supervision.

Also, said 12-year-old will need to undergo a PAP smear, as "the pill" does the risk of cervical and breast cancer. (However, both are easily treatable in their early stages, hence, bi-yearly/yearly examination.)

I shall refrain from my feelings on people using the ED as a primary care facility, as this mother was doing. ER Doc refered them out to the approriate facility, as he (you're a guy, right?) should have.

This mother sounds like a crappy parent (my own parents would have beat me half to death if I willingly had sex at that age) and yeah, Child Protective Services should have been notified and this situation sounds like a royal fuster-cluck in more ways than one.

ER Doc, keep writing, as I do enjoy your blog. Our blogs, our opinions, go elsewhere if ya don't like it. =D Good English isn't always possible when you're dead tired.

*crawls back to ambulance driver cave*

Ladyk73 said...

Actually....alot of girls postmenarchal by 12. Children are maturing so much earlier than past generations. People worry it is the hormones in the chicken, might be that people are well nourished. Alot of young teens look older too. I wonder is ethnicity has something to do with it.

I know a 2nd grader that looks like a tween

Dr. Dawg said...

Just an FYI to those saying the 12 year old needed an exam.

New ACOG guidelines state no PAP needed prior to age 21 no matter when they become sexually active. This is due to the fact that many teens may have a cervical reaction to exposure to HPV virus but will successfully fight it off and not need all the colpos/cones/cryos etc that were being done all the time in the past.

Barring evidence of an STD or signs of abuse there would be no need for any further work up in the ED setting. If you wanted to work up all the sexually active 12 year olds in ANY town, sadly you'd be pretty busy.

Neither of these patients should have even BEEN in the ED. Mom could have seen her PCP, her OB/GYN, or the local health department. The daughter could have seen or called her pediatrician or mom could have bought Plan B OTC for her.

After all it is an EMERGENCY DEPT not a "well you're open so we came here" department.

OB/GYN said...

no ED MD would write an Rx for OCPs? are you freaking kidding? especially to an apparently sexually active 12-year-old? if you're not even willing to call a consult, then please don't call me when she shows up with an SAB or ectopic (highly likely given her age and sexual Hx). don't even get me started on your use of the "abortion pill" bullshit. act like a doctor, and a grown up - you come off no better than that 12-year-old and her mother...

Texas Pharmacy Chica said...

Yep. Federal law states it is a felony to sell OTC Plan B to underage girls, so I hope you did not get one of my fellow RPhs in trouble. Oh, well, the RPh was probably just cussed from Hell to Hades by this duo for his/her apparent incompetence, no harm done....

And yes, some of us really do take the counseling bit seriously. I want to counsel the end-user....not the d00d with the Linkin Park shirt and $400 phone.

Anonymous said...

20 cents say Anonymous January 18, 2011 1:34 PM is the Serenity Hospital Now ER Doc with his head up his a**

Anonymous said...

Okay, I am joining this one late but....

Those first 3 comments sound like some bra-burning bitches!!!!