The other night I faced a dilemma. There was a 17 year old female patient in with abdominal pain – which halfway sounded GYN and halfway sounded GI in origin. She had some non-so-common medical conditions as well. First she had precocious puberty when she was 5 and was on Lupron to push it off until she was 12. Then she had her first period two years later. This corresponded with the development of anorexia nervosa which caused her to lose weight, develop abnormal liver function, and required her to be in counselling and on psych meds. Now, 3 years later, the anorexia was under control and she was off all meds – although still seeing a therapist. She was normal weight but still had irregular periods. She was recently started on provera to induce a period.
Now, the hard part was that her mother specifically asked me NOT to put down in her medical record that she had anorexia. I asked her if she was officially diagnosed with it and had specific treatment for it to which she replied yes. I told her I really should since it is important but she was insistent that I do not.
I was halfway thinking her pain was related to her liver and or GI issues but also the amenorrhea and GYN history also came into play.
I elected not to write it down in the record but felt like it was wrong to do it. Why didn’t they just not tell me she had anorexia!!?!?!? Tomorrow I am going to find out what ultimately caused her symptoms – and to see if anorexia might have played a role.