Paternity Testing Request

Brandy Redding

23 years, Female

Role-play cases simulate real clinical practice to guide how candidates respond to clinical scenarios and real life practice.

Name: Brandy Redding
Age: 23
Gender: Female
Occupation: Waitress
Opening Statement: 'm here today because I'm 14 weeks pregnant and I'm feeling really anxious about something.

History
Brandy Redding, a 23-year-old waitress, presents with a request for a paternity test. She is currently 14 weeks pregnant and is uncertain about the paternity of the baby. Brandy had a one-off sexual encounter a few weeks ago, during which she experienced a post-coital vaginal bleed that was not characteristic of her normal menstrual cycle. She is currently in a long-term relationship and is anxious about the potential impact of the paternity uncertainty on her relationship.

Medical History

Obstetric History: Currently 14 weeks pregnant. Registered for antenatal care (ANC). She wants to keep her pregnancy.
Gynecological History: No significant past gynecological issues reported.
General Health: No chronic illnesses. Does not smoke, and stopped drink alcohol upon discovering the pregnancy. Generally healthy and engages in regular physical activity, including Pilates.
Current Medications: Taking over-the-counter prenatal vitamins, she does not know the dose but the midwife says they were ok.

Social History

Lifestyle: Brandy enjoys her job as a waitress and plans to start evening college next year. She values staying fit and incorporates Pilates into her routine.
Dietary Habits: Eats healthy diets, she loves cheese and seafood but she is not unaware of specific dietary recommendations or restrictions for pregnancy.
Substance Use: No smoking history; stopped drinking alcohol after confirming pregnancy.
Relationship Status: She is in a long-term relationship, which she is keen to maintain. She is hesitant about disclosing the one-off sexual encounter to her partner, she wants to keep her relationship
Future Aspirations: Plans to continue working and pursue further education. Uncertain about the impact of having a baby on her future plans.

Psychological History

Mental Health: Experiences occasional anxiety but has not sought professional help. The current situation regarding paternity is a significant source of stress for her.

You are a doctor in your routine clinic, ready to begin your day of consultations. A patient has been booked to see you,

Name: Brandy Redding

Age: 23 years, Female

Past Medical History: No significant medical history (Nil)

Medication History: No known drug allergies (NKDA)

Clinical Notes: No additional notes.

Investigation Results: No investigations conducted.

In this case, the key issues for a GP to manage would include:

1. Paternity Concerns

Paternity Testing: Providing information about the available options for paternity testing, including non-invasive prenatal paternity tests.
Counseling and Support: Offering support to help Brandy manage her anxiety and guiding her on how to approach the topic with her partner.

2. Antenatal Care

Routine Antenatal Care: Ensuring Brandy receives regular prenatal check-ups to monitor the health and development of the baby.
Diet and Nutrition: Educating Brandy on dietary recommendations during pregnancy, including which foods to eat and avoid, with a specific focus on her love for cheese and seafood.
Supplementation: Confirming that the over-the-counter vitamins she is taking are appropriate for her pregnancy.

3. Mental Health

Anxiety Management: Addressing her anxiety, which may include discussing lifestyle changes, stress reduction techniques, and possibly referring her to a mental health professional if needed.
Support Systems: Encouraging her to seek support from trusted friends, family members, or support groups for pregnant women.

4. Relationship Dynamics

Communication: Offering advice on how to communicate with her partner about the paternity uncertainty in a way that minimizes conflict and promotes understanding.
Couples Counseling: Suggesting couples counseling as a resource to help navigate the relationship challenges this situation may present.

5. Future Planning

Education and Career: Discussing her plans to continue working and attend evening college, and how she can balance these with the demands of motherhood.
Childcare and Support: Providing information about childcare options and other support services available to her as a working mother and student.

6. General Health and Lifestyle

Exercise: Advising on safe exercises during pregnancy, considering her routine of doing Pilates.
Substance Use: Continuing to support her in abstaining from alcohol and reinforcing the benefits of not smoking during pregnancy.

Summary of Key Issues:

Paternity Testing and Related Counseling
Comprehensive Antenatal Care
Mental Health and Anxiety Management
Navigating Relationship Dynamics
Future Planning and Support for Education/Career
General Health and Lifestyle Guidance

By addressing these key issues, the GP can help Brandy manage her pregnancy effectively, reduce her anxiety, and provide her with the necessary support to navigate her current challenges and future plans.

These are the key issues in this clinical scenario.

Marking Scheme for Paternity Request

1. Data Gathering and Diagnosis
Criteria:

Comprehensive History Taking:Gathered detailed history of the current pregnancy
Explored current pregnancy status, asked 'health start questions' and excluded red flags for pregnancy.
Inquired about current medications, including over-the-counter vitamins (5%)
Investigated lifestyle factors such as exercise, diet, substance use.
Discussed mental health, particularly anxiety and any previous episodes or treatments.
Assessed social history, including relationship status, support systems, and future plans.

Descriptors:

Thoroughly documented all relevant information.
Identified key aspects of patient's medical, psychological, and social history.
Demonstrated an understanding of the importance of each aspect in the context of pregnancy.

2. Inter-personal Skills.
Criteria:

Empathy and Reassurance: Displayed empathy towards patient's anxiety and uncertainty about paternity.
Provided reassurance regarding the availability of support and management options.
Communication Skills: Used clear, non-judgmental language (5%)
Ensured Brandy felt heard and understood (5%)
Professionalism and Sensitivity:Maintained a professional demeanor while being sensitive to Brandy’s concerns about her relationship and future (5%)

Descriptors:

Effectively built rapport and trust with Brandy.
Demonstrated active listening and provided appropriate emotional support.
Communicated clearly and respectfully, ensuring Brandy felt comfortable discussing sensitive issues.

3. Clinical Management
Criteria:

Management Plan: Offered detailed information about paternity testing options, including non-invasive prenatal paternity testing.
Provided advice on antenatal care, including dietary recommendations and safe exercise.
Suggested resources for mental health support, such as counseling or therapy for anxiety.
Discussed strategies for addressing the paternity issue with her partner, including potential referral to couples counseling.
Supported her future planning, providing guidance on balancing work, education, and motherhood.

Descriptors:

Developed a comprehensive and individualized management plan.
Demonstrated knowledge of appropriate interventions and support services.
Ensured Brandy was informed and involved in decision-making regarding her care.

Approach: Women’s Health.

Follow the consultation steps.
Ask about the pregnancy; number, order, previous pregnancy, LMP, was it difficult getting pregnant?
Ask about planned, accepted – do not be too quick to give congratulation without checking if appropriate. How does she feel about being pregnant?
Red flags; PV bleeding and discharge, Abd pain, fetalmovement if preg > 20 weeks + appropriate clinical red flag for case.
Past Medical History: Think DM, Epilepsy – folic acid requirement, complications in pregnancy.
Contraception and cervical smear
Partner – Where? Supportive? How do they feel about the pregnancy?
Finances and career (Impact, PSO)
ANC – Healthy Start Questions

Clinical Management
• Agenda setting in your clinical management – gives you structure.
• Laws regarding paternity testing: private, only licensed gov labs, will need to partner involvement (DNA testing consent: it is illegal to do any DNA test without consent) - https://www.gov.uk/paternity-pay-leave
• State you will talk about managing clinical and then other pregnancy aspects.
• If noted parts of healthy start not done, need to address.
• if unplanned pregnancy requesting TOP, will need contraception afterwards
• If pregnant asking about Down’s syndrome, need f/up to offer more support after screening.
• Keep medical options short and feasible. Address any emergency.
• Negotiate; show understanding of the unique situation pregnancy has on parenting, career, etc.

Healthy Start Scheme

Registered for ANC? – got their pregnancy pack? What has been done/shared? (open question)
Dating Scan – depending on age of pregnancy (some patient may have early private scans).
Vitamins – folic 400mcg (5mg in risk of neural defects, DM, epilepsy) + 10mg Vit D (10mcg daily)
Food to avoid: Vit A, liver, blue-cheese (Listeria), fish high in methylmercury or partially cook meats/fish/egg.
Fish to eat: healthy meals + peanuts (if not allergic), limit caffeine to 200mg (one mug daily, caffeine also present in coffee, tea, chocolate, and colas.
Annual flu vaccine
Lifestyle: Exercise, Smoking, Alcohol, Stress
Avoid OTC meds not prescribed – can speak to pharma
MATB1 certificate, Paternity Leave, NHS Prescription Exemption.