Teachable moments

Patient History

Peter Fernandez, an established 14-year-old patient with your practice, presents with his mother, Sasha, who is concerned that he is depressed and not interested in school anymore. She wants to know if he could have some undiagnosed illness causing his lack of interest in activities.

Prior to going into the exam room, you briefly review Peter’s chart. Well-child visits and immunizations are up-to-date and he has been doing well in school and with friends as of his last visit one year ago. His only medical history is a fractured distal radius at age of 12 years and allergic rhinitis controlled with a systemic antihistamine.

Family Social History:

• Ms. Fernandez has been married for 18 years to her husband, Enrique. Peter is their second child. He has a 17-year-old brother, Carlos, and a 12-year-old sister, Monica.
• Mr. Fernandez works for a large corporation and travels at least once a week. Sasha is a stay-at-home mom and volunteers regularly at the local middle school library. Peter’s older brother, Carlos, is the star quarterback for high school football team.
• Remaining social history reveals that the family lives in suburban Chicago with no surrounding industries, home built in mid 1970s.
• His father smokes cigars occasionally. His mother does not smoke.

You enter the exam room and find Peter sitting in a chair and Sasha sitting beside him. The room is quiet. You introduce yourself and Sasha greets you but Peter stares at the floor.

Development:

You begin with a brief conversation with Peter and his mother, explaining that you will need time to speak with Peter alone as part of his physical exam and that information he shares with you is kept confidential unless there is a serious safety concern. Ms. Fernandez says she understands this. Initially, she does most of the talking, while Peter responds with one-word “yes” or “no” answers or shrugs his shoulders. Mom reports that in the past six months Peter has gone from a B+ student to a D student, that he seems to have no interest in school and has missed many days due to complaints of a headache or a stomach ache. He quit the cross-country team three months ago, stating he didn’t care about doing sports anymore. You acknowledge her concerns and then ask to see Peter privately. Ms. Fernandez smiles and proceeds to the waiting room. You begin a conversation with Peter.