The 15-year-old asking for the pill — in confidence

PLAB 2 & PRES 3 · ethics / sexual health · medium · 10 minutes

Candidate brief

You are an FY2 doctor in a GP surgery. Amara Osei, 15, has booked an appointment on her own after school. She says: "I need to go on the pill. I've been with my boyfriend for four months and… it's got to that stage. You can't tell my mum — she'd actually kill me. She thinks I'm at a study group right now." Please take a history, assess the situation and manage her request.

What examiners look for

Under-16 contraception is governed by the Fraser guidelines (from Gillick): understand the advice; cannot be persuaded to tell parents; likely to have sex regardless; health likely to suffer without it; best interests require providing it. All five met + a safeguarding screen = prescribe confidentially, and document the assessment like it will be read aloud somewhere formal — it is the consultation's legal skeleton. Confidentiality for a competent young person is the SAME duty as for an adult: her mother has no right to the information, however loving the motive, and "she'd want to know" is not a lawful basis for disclosure. The one exception is unchanged — risk of serious harm — which is why you state it at the start: a limit declared upfront is professionalism; the same limit sprung later is betrayal. The safeguarding screen is what separates a competent young person's private healthcare from a red flag missed in plain sight: partner's age, coercion, gifts and intoxicants, online contacts, the under-13 absolute line. Ask the questions plainly and without flinching; a 15-year-old can tell when she's being protected and when she's being investigated, and the tone decides which answers you get. Note what refusal would actually achieve here: not chastity — unprotected sex plus a teenager who will never trust a GP with a crisis again. The Fraser framework exists because Parliament's alternative was tested against reality and lost: the health of the girl in front of you outranks the comfort of everyone else in the story. And keep the family door oiled, not forced. "Not today" from a girl who has been treated respectfully is the beginning of most eventual disclosures; she goes home safer, with a sister who knows, a doctor she trusts, and a mother she may tell at 17 instead of a pregnancy she must announce at 15.

Guideline references

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