Tiffany: Yeah, I get it. I just want this acne to go away.
Dr. Murphy: Ok, great. To move forward, in addition to monthly pregnancy testing, you will either have to sign an abstinence pledge or commit to two forms of birth control that you will use throughout your treatment. The most common forms are the birth control pill and condoms. This part is critical.
Mrs. Jones (interjecting): Oh, Tiffany will be signing the abstinence pledge. She will definitely not be going on birth control. She will not be using this prescription as a pass to start having sex.
Tiffany (shrugs and looks dubious): Ok.
Dr. Murphy (addressing Tiffany): I need to hear from you about how you feel about this because this is a medical decision that affects your body and your lifestyle.
Tiffany (looks down hesitantly): I guess I’ll go ahead and sign the pledge.
One day later ...
Tiffany: Hi, Dr. Murphy. My boyfriend drove me back to come see you today. I didn’t want to say it with my Mom in the room, but I think I really want to be on birth control. I just didn’t want to upset her. I’ve been dating my boyfriend for 13 months and we haven’t had sex yet, but I would just rather be ready for when we decide to do it.
Dr. Murphy: I appreciate you coming back to see me. I know it’s a tough decision, especially with such a stringent medication routine. Of course, we encourage honesty with your mother about your medical choices, however, legally, I am not required to inform your mother that you are seeking contraception. Ultimately, this decision is yours to make. At the same time, I have to emphasize how crucial it is that you adhere to taking the birth control. You would have to commit 100% to taking contraception as directed.
Tiffany: Thanks. Yeah, I’d like the prescription and for you not to tell my mom, she’d freak! You saw how strict she was. She still treats me like a kid.
Dr. Murphy: I understand. Do you think you can commit to taking the contraceptive daily as directed?
Dr. Murphy: OK. I feel comfortable prescribing you birth control -- again, as long as you take it as I've instructed. And don’t forget, if you engage in sexual activity while on Accutane, you will also need a second form of protection -- I would suggest condoms. You will need to use 2 forms of contraception for a month and take a pregnancy test before I can start you on Accutane. In the meantime, let’s talk a little about birth control pills, how it works, how you’ll need to take it, etc ...
Several months later: Treatment has started, Tiffany & Mom come in for a follow-up visit
Dr. Murphy: Alright, so your pregnancy test has come back negative. Mrs. Jones, I have a few questions that I need to ask your daughter in private. I’m going to ask you to step out of the room for now. You can schedule the next visit while we chat. I’ll come get you when we’re finished.
Mrs. Jones leaves the room hesitantly
Dr. Murphy: Ok, Tiffany. I need to ask a few questions about your current sexual activity for your safety given that you're now on Accutane. Have you and your boyfriend decided to have sex -- specifically vaginal intercourse?
Tiffany (embarrassed blushing): Yes.
Dr. Murphy: OK , how are things going with the birth control I prescribed you last month? Have you been taking it everyday?
Tiffany: Fine. I take it most days of the week.
Dr. Murphy: Does that mean you are missing doses?
Tiffany: Yeah, I miss a dose here and there.
Dr. Murphy: How often would you say you miss doses?
Tiffany: Umm, probably one pill a week-ish?
Dr. Murphy: Can you tell me why you are missing doses?
Tiffany: I guess I forget sometimes or am too busy to take it.
Dr. Murphy: Ah, ok. Well, I understand how challenging it can be to remember to take medication. However, as we discussed previously, it’s really important that you take ALL doses, every day at the same time each day. Unless we can figure out a way for you to take your birth control EVERY day, I’m not going to be able to continue prescribing you Accutane. It’s just too risky for your health and your baby’s health, if you were to get pregnant.
I know how important it is to clear up your skin and I’d like to be able to continue prescribing your Accutane.
Dr. Murphy stops to weigh her options...