A 66-year-old male is referred by his primary care physician to your general surgery

A 66-year-old male is referred by his primary care physicia physician to your general surgery clinic for further work-up and assessment of a right inguinal hernia. While you are obtaining the patient’s history, he embarks on a lengthy diatribe voicing his dissatisfaction with the care he is receiving from his primary care physician. Specifically, he believes that his diabetes medications are being mismanaged and is frustrated with the lengthy wait times he experiences prior to office visits. Which of the following is the most appropriate action or response?

    1. Agree with the patient that his diabetes is being poorly managed and suggest that the patient bring up the topic at his next appointment
    1. Tactfully disregard the patient’s complaints and continue with the interview; contact the primary care physician at a later date to alert him/her to their patient’s dissatisfaction
    1. Acknowledge the patient’s frustration and suggest that he express his concerns directly to his primary care physician
    1. Evaluate the patient’s current regimen of diabetes medications and make changes as you see necessary
    1. Suggest that the patient transfer his care to another primary care physician

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Teenagers should have an opportunity to speak with the physician alone during their visit; this is especially important for topics that might be uncomfortable to discuss in front of parents. A good strategy is to ask the parent to leave the room for the physical exam portion of the visit and ask questions regarding more sensitive topics at that time.

Assurance that the adolescent’s visit with the physician is confidential will invoke the patient to give a more accurate history, allowing for improved care and counseling that the physician is able to provide. Although laws vary by state, there are several issues on which parental consent is generally not required for adolescents, including: pregnancy management, sexually transmitted disease treatment, substance abuse, psychiatric disorders, abuse, and contraception.