EXERCISES: COUNSELING AND INFORMED CONSENT

EXERCISE 2.1: Pregnancy options counseling and screening

Purpose: The following exercise is designed to review pregnancy options counseling. Consider role-playing the following scenarios. 

1. One of your patients presents with an unexpected positive pregnancy test during clinic or in the ED. How would you approach this? See Teaching Points

2. When you ask a patient what questions they have, they want to know if an abortion will affect their ability to have children in the future. How would you respond? See Teaching Points

3. A patient is leaning toward adoption but is trying to decide, and wants to know more about the process and options. How would you respond? See Teaching Points

4. While you are explaining the protocol for a medication abortion to a patient, they mention that their boyfriend “absolutely cannot find out about this pregnancy.” What concerns does this raise and how can you explore the situation further? What assurances can you give them, what support may you want to offer them? See Teaching Points

5. You receive a phone call from a man who would like to schedule a medication abortion for himself. What questions should you ask during intake and counseling? See Teaching Points

6. You have a 19-year old patient who has been to the clinic for several abortions in the past. Her first abortion was when she was 14. She is always accompanied by an older male relative. You are concerned she may be the victim of sex trafficking. What questions might you ask? What should you do if you find out she is the victim of trafficking? See Teaching Points

EXERCISE 2.2:  Counseling around clinical care

Purpose:  Discuss what you might do or what you might say to the patient in each of the following situations in the context of a uterine aspiration for abortion or early pregnancy loss.

1. As you enter the exam room you hear the patient’s partner criticizing them for “acting stupid” and telling them angrily to “just shut up.” The partner is looking at the wall and ignores your efforts to introduce yourself. See Teaching Points

2. When you come into the room and ask the patient how they are feeling, the patient starts crying uncontrollably. They have their head turned away from you and do not make eye contact. See Teaching Points

3. The patient is a 14-year-old rape survivor who is 7 weeks pregnant. Every time you attempt to insert the speculum, they raise their hips off the table. See Teaching Points

4. You are about to see a 22-year-old G0 patient with a mild motor and cognitive disability. She arrives in clinic in a wheelchair with her mother. During the intake, the mother states that she would like to discuss birth control that will assist her daughter with periods. See Teaching Points

5. You have just completed an aspiration for a patient at 8 weeks gestation. The patient asks, “Can I see what it looks like?” How would you respond? How would your response differ at 12 weeks gestation? See Teaching Points