Monday, August 8, 2011

How to talk to teens

I had a really frustrating experience in the ED the other day.

I needed a urine specimen from a teenager. Everything had been ordered and I was busy dealing with an actual emergency (it does happen sometimes!) when the nurse came up to me and told me that the patient was refusing to provide a urine specimen and she needed me to talk to the patient.

So I went in to the room and said "I heard you had some questions about the urine specimen. What questions can I answer for you?" The teenager refused to even make eye contact with me. The mother said "She doesn't want to pee in a cup."

"Okay..." I responded, a little confused for how the mom became the spokesperson for this decision. I addressed the teenager again "can you tell me why not?"

She shrugged, but neither her nor her mother proffered an answer. I was a little frustrated, but it also seemed like no one had tried the common sense response so far, so I decided to go for it. "I think that you probably think that it's gross to pee in a cup. To be honest, I know it's weird and it feels strange. Unfortunately, I need for you to do it so that I can make sure you're healthy, so not providing a urine specimen isn't a choice right now. The choices are that you can pee in a bed pan, you can pee directly into a cup or you can pee in a hat (a thing you place on the toilet to catch urine.) If you don't like any of those options, we can use a bladder catheter, which is a tube that we put into your bladder through your urethra. Those are the only choices I can offer you right now. Do you have any questions?"

She now made eye contact. I held my gaze steady. I was pretty willing to be the adult in this circumstance. She shook her head. "OK. Do you have a preference?" She shook her head again. "OK, I'll have the nurse come in and show you the hat and the bed pan and you can choose."

She peed in a bed pan.

The demographic in the emergency department is always a little different. A lot of times we have parents who just don't know how to tell kids that certain things aren't options. Certainly, not all parents are this way (and in the particular case that this is based on the parent was a great parent, who was just at the end of her rope for reasons that weren't relevant to the story.) I was pretty impressed by how easily I reached consensus on what was going to happen. Sometimes, it just takes firmness and explaining what is and is not up for discussion.

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