In medical school we are routinely taught to appreciate the importance of evidence-based medicine with the gold standard of evidence being randomized clinical trials, systematic reviews and meta-analyses. Evidence obtained from case reports on the other hand is generally regarded as relatively low quality. In this new era of evidence-based medicine case reports may therefore be considered unnecessary – something which is precipitated by some journals limiting the number of case reports published due to their relatively low citation potential affecting the journal’s impact factor (calculated by the average number of citations per article).
A 14 year old girl was seen in clinic after an injury whilst playing rugby. Although her description was vague, she intimated that a valgus stress had been put on her left leg and described being tackled in rugby practice. She fell on her left knee and heard an audible cracking or ‘pop’ sound, experiencing immediate pain and swelling of the joint. She had no significant past medical history and was taking no regular medication.
This paper attempts four things:
(1) to identify uncertainties and ambiguities in English law and medical guidance concerning the circumstances in which a competent adolescent patient who refuses a clinically indicated treatment can be overruled by a court of law in their own best interests;
(2) to clarify the nature and sources of two opposing attitudes towards the matter of the extent and limits of an adolescent patient’s right to refuse clinically indicated treatment;
(3) to argue for the need to set up in hospitals a Liaison and Mediation Service to facilitate communication between an adolescent who refuses treatment and their doctors with a view to developing, if possible, an agreed decision; and
(4) to outline a widened conception of an adolescent’s best interests which includes, besides the restoration of their health, respect for their personality and autonomy, acknowledgement of their right to be informed about the treatment proposed to them, recognition of their capacity to gain considerable understanding of the nature and consequences of the treatment and any alternatives, and also acceptance by doctors and judges of their ability to make their own decisions which is commensurate to the degree of intellectual and emotional maturity they have attained.
Mental health in pregnancy remains a significant issue, with 7-13%  of women experiencing depressive symptoms during pregnancy. ‘Confidential Enquiries into Maternal Deaths in the United Kingdom’  have highlighted suicide in pregnancy and during the first postnatal year as a leading cause of maternal death. SSRIs are known to cross the placental barrier, however the safety of these drugs in pregnancy is not well understood .