A 21 year old female came for contraception prescription and refused to do STD screening.

Explanation

Core Concept: The ethical principle of patient autonomy dictates that a competent adult has the right to refuse any medical test or procedure, including sexually transmitted disease (STD) screening. Withholding contraception as leverage violates ethical guidelines and increases the risk of unintended pregnancy.

Clinical Presentation:

• Patient seeking reproductive health services but declining screening.

Diagnosis:

• N/A.

Management:

• Acute: The physician must inform the patient about the risks and harms of untreated STDs (e.g., pelvic inflammatory disease, infertility, ectopic pregnancy) to ensure informed refusal. Following this counseling, the physician must respect her autonomy and prescribe the requested contraception.
• Long-term: Maintain a non-judgmental therapeutic alliance and offer screening again at future visits.