A 16-year-old girl comes to the office for a routine health maintenance examination. Her mother accompanies her and remains in the room. The patient appears healthy and reports no concerns. After completing the physical examination, the physician asks the mother to step out to speak with the patient privately. Once alone, the patient reports that she has been sexually active with her boyfriend for 3 months and wants to start oral contraceptives. She says her mood has been 'okay' but admits to feeling 'stressed' about school. She denies suicidal thoughts, substance use, or concerns about her relationship. Which of the following is the most appropriate next step?
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AOrder pregnancy test and sexually transmitted infection screening before prescribing contraception
BPerform confidential screening for depression and risky behaviors, then discuss contraception
CInform the mother of the patient's request and obtain parental consent for contraception
DPrescribe oral contraceptives and schedule follow-up in 3 months for monitoring
ECounsel on abstinence and defer contraception discussion until she is 18 years old
✓ Correct answer: B. Perform confidential screening for depression and risky behaviors, then discuss contraceptionAdolescent visits require confidential screening for depression, sexual behavior, and substance use per HEEADSSS assessment guidelines. The patient's request for contraception and report of stress warrant depression screening before prescribing. State laws generally allow minors to consent for reproductive health services. Distractor1 violates confidentiality and adolescent autonomy. Distractor2 misses depression screening opportunity. Distractor3 focuses on less immediate concern. Distractor4 is premature without comprehensive screening and counseling first.
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