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Retired NBME Step 2 CK Form 6 Answers
ronabobonafofona
Process of elimination question for me.
The only other decent choice was A, but you wouldn't recommend "punishing" the patient if she doesn't comply. Maybe you just wouldn't offer her reward.
Therefore, B makes the most sense. I think of it like trying to bargain with the girl -- "if you take the medication, then we'll do x for you". Something to incentivize good compliance.
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keyseph
I agree that it was mainly by process of elimination to get to the right answer. Negotiating a contract is also the only answer that has some leeway to talk to the patient about why she doesn't believe she needs the medication.
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jlbae
Also, we're talking about a 15F here. If you were a 15F and your physician basically said, "hey, let's write up a plan so that if you take your meds as scheduled for a week, then your mom and dad will give you a $20 Amazon gift card to save up for some new shoes" then you would hold your parents to it. YOU HAVE TO BUY ME NEW SHOES NOW BECAUSE DR. X SAID YOU WOULD IF I TAKE MY ASTHMA MEDS MOM!!!!
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lindasmith462
its kind of a weird answer - medication contracts are typically utilized for controlled substances. its not a legal document - they're really just a written agreement btwn a physician and pt about their meds and treatment regimen, the pros/cons of adhering/non adhering to said regimen, and the actions that will be taken if the contract is broken (aka if you come in and don't piss positive for the opioids I prescribe I stop prescribing them/fire you from the practice). Probably not totally appropriate for an adolescent who doesnt have full decision making capacity yet.
I think it's getting at the underlying principals of adolescent non-adherance which is that as they go through normal behavioral changes with being more autonomous in their life they attempt to "take control" of their health through non-adherance. Therefore to improve adherence it is best to "contract" with the patient and make a plan together putting them in more control over their health.
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lindasmith462
also while mental health issues may increase risk of medication non adherence in adolescents it is a normal behavioral age related change
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lindasmith462
parents rewarding/punishing her still keeps the control of her treatment out of her own hands. obvi not enough signs of other mental health conditions to start any of the meds
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daniyal_ishtiaq
what if the child breaks the contract or lies about taking the meds. there was a similar question in step1 UW and some assessment forms that said that studies shows in adolescents the best approach is to join them up in a similar group as they learn a lot from their peers.
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submitted by โshastri96(17)
can someone please explain this ? why would we negotiate a contract with a minor ?