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1220. Initial post case study #1COLLAPSE This week’s discussion question is going to be about a 16yo caucasian female who comes into the office with her grandmother for an annual exam. The grandmother reports that BK has been “acting strange, and staying in her room all the time and refusing to do all the things she used to enjoy like singing in the youth choir”. The grandmother also shares that BK’s mother is a drug addict and is currently incarcerated so she is worried BK is using drugs and wants her tested for drugs. BK is not on any medications. She is obese and does not make eye contact when I enter the room.  The first thing as a provider is to introduce myself when I walk in the room. I’d start by telling them my name and I’d ask how everyone is doing today. By doing this, I hope to start building the patient’s trust with me so she feels comfortable enough to start opening up to me. “Patients have to trust their health care professionals to work in their best interest and outcome [6]. In this regard, trust in the health care professional has been suggested to be the foundation for effective treatments [7, 8] and fundamental for patient-centered care [9].” (Birkhäuer, 2017, para 6)  I would address the grandmother’s concern about the patient being withdrawn from her usual activities by asking if anything has happened recently like the loss of a loved one or a traumatic event to cause the current actions of the patient. Once the grandmother answers my question, I’d ask the grandmother if she could step back out into the waiting room, I’d also ask the patient if that would be ok as well. I would then proceed to ask the patient about her daily routine at home and school and if something has happened to make her withdrawn. I’d also inquire about her sexual status and if she’s sexually active. Depending on her response, it could warrant for a pregnancy test.  I’d also do a depression screening on her. According to American Journal of Preventive Medicine “Adolescents’ perceptions of low parental caring, difficulty talking to their parents about problems, and valuing their friends’ opinions for serious decisions were significantly associated with compromised behavioral and emotional health.” I hope that by talking to BK one on one helps her feel comfortable and not so pressured to answer the way her grandmother wants her to.  Last but not least, according to the International Journal of Current Research “Most adolescents who use drugs do not progress to become drug abusers, addicts in adulthood, drug use in adolescence are a very risky proposition. Typically, school and relationships, notably family relationships, are among the life areas that are most influenced by drug use and abuse. ramifications. The numerous adverse consequences associated with teenage drinking and substance use disorders include fatal and nonfatal injuries from alcohol accidents, practices.” (Sathyamurthi,2020, para 1)  I would ask BK about her thoughts on her mother and how that makes her feel. I’d also ask her if she ever tried any drugs or thought about it. Given the patient’s physical appearance and behavior, I don’t believe that she is on drugs and don’t feel the need to drug test her. I would speak with the grandmother in my office by herself about this topic and my opinion on it. I’d also let the grandmother know that I believe her granddaughter is suffering from depression. I would then bring the grandmother back into the room and go over my diagnosis with both parties and what the current treatment is to help BK going forward. By doing this, I hope to continue building my trusting relationship with both the patient and the grandmother.  6 Questions Have you recently experienced any traumatic event   How is your home life and school life   Are you depressed   How does your mothers situation make you feel   Are you or have you ever used drugs or alcohol   Are you sexually active   Reference Ackard, D. M., Neumark-Sztainer, D., Story, M., & Perry, C. (2016). Parent–child connectedness and behavioral and emotional health among adolescents. American Journal of Preventive Medicine, 30(1), 59-66. doi:10.1016/j.amepre.2005.09.013 Birkhäuer, J., Gaab, J., Kossowsky, J., Hasler, S., Krummenacher, P., Werner, C., & Gerger, H. (2017). Trust in the health care professional and health outcome: A meta-analysis. PloS one, 12(2), e0170988. https://doi.org/10.1371/journal.pone.0170988 Sathyamurthi, K., Agalya, S., & Anjana, M. (2020). ADOLESCENTS SUBSTANCE USAGE IN The neighborhood community of chennai. International Journal of Current Research, 12(6), 11988-11990. doi:https://doi.org/10.24941/ijcr.39005.06.2020

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