A 13-year-old kid is brought to the doctor by his mother for a standard medical examination and type 1 diabetes mellitus follow-up. "Here's the doctor; he's going to tell you how terribly you've been doing," his mother exclaims at the start of the appointment. Laboratory tests reveal a random blood glucose of 350 mg/dL and a hemoglobin A1c of 9% (normal: 6%-7%). When the doctor asks how the patient is doing with his insulin, his mother interrupts and exclaims, "He never remembers to use it!" When asked about the boy's diet, his mother puts her hands on her hips, glares at him, and exclaims, "Pizza, soda, and sweets!" After addressing the mother's worries about diabetes management, which of the following is the most appropriate course of action?

Question

Quizplus · Accepted Answer

Eductional Objective: This patient's type 1 diabetes is poorly controlled on his current medication regimen, as evidenced by a random blood glucose level of more than 200 mg/dL and a hemoglobin A1c of 9.0 percent. An irate, critical father confronts the physician and refuses to let the patient speak. Continuing the visit in the presence of the patient's mother would almost certainly result in ineffective confrontation or the patient pacifying his mother by agreeing with her or enabling her to speak for him. The best course of action is to acknowledge the mother's concerns and politely ask her to wait outside while the physician speaks with the patient privately. This will allow the patient to be more open about his difficulty managing his diabetes and to discuss any personal concerns that may be having an impact. All adolescent visits should include an opportunity to interview the patient alone to discuss topics such as drugs, alcohol, tobacco, and sexual activity.

A 13-Year-Old Kid Is Brought to the Doctor by His