The silent teenager — abdominal pain, two histories

PLAB 2 & PRES 3 · paediatrics / history taking · hard · 10 minutes

Candidate brief

You are an FY2 doctor in a GP surgery. Chloe Hartley, 14, has been brought by her mother with abdominal pain. Her mother does most of the talking: three weeks of intermittent lower abdominal pain, some missed school, "probably her periods starting to settle — or anxiety, doctor, she's always been a worrier." Chloe sits silent, hood up, answering in shrugs. Your practice routinely sees teenagers alone for part of the consultation. Please take the history — managing both parts of this consultation — and explain your plan.

What examiners look for

The most important instrument in adolescent medicine is a closing door. Family consultations present you with the family's version of the patient — curated, narrated, and in this case flatly wrong about dates, causes and the girl herself. Routine, unremarkable alone-time ("we always do this") is how you meet the actual patient without declaring war on her mother's version. Confidentiality is the key that opens the door — but it must be an honest lock, not a trick one. State its limit (serious risk of harm) and its hard case (a pregnancy cannot be concealed for nine months, and she deserves help telling, not a promise she'll never have to) BEFORE the disclosures, so that everything she tells you is given with informed trust. The teenager who hears the limits first and still talks has consented to the real arrangement. Count the problems separately. Six weeks of amenorrhoea needs a test today; three months of pain that predates it needs a work-up this month. Fear fuses them ("it's all because of what I did"); the clinician's job is to unfuse them — medically, because the tracks diverge, and emotionally, because she is currently experiencing her pain as punishment. Fraser principles run through this station quietly: a competent 14-year-old receives sexual-health care — testing, contraception, pregnancy options — in confidence, with safeguarding assessed rather than assumed. Pear-age, consensual, uncoerced activity is a healthcare matter. Your visible lack of shock is not laxity; it is the clinical technique that made the history possible. And end as you promised to begin: the joint summary contains exactly what she agreed it contains. Every adolescent in the waiting room is watching what happens to the last one's secrets.

Guideline references

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