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On My Mind
June 2017

When Good Intentions Are Not Enough

Author Affiliations
  • 1American University of Beirut Medical Center, Family Medicine Department, Beirut, Lebanon
JAMA Pediatr. 2017;171(6):513-514. doi:10.1001/jamapediatrics.2016.4969

It was supposed to be a straightforward case: a 13-year-old Syrian refugee girl was brought by her mother for irregular menstrual cycles. The girl started menstruating 9 months earlier and had 2 periods since then. My colleague, who was attending to the case, was unsuccessful in convincing the mother of the futility of performing a workup at this stage; he offered seeking another opinion for reassurance.

After reviewing the history and clinical examination notes, I asked the mother why she wouldn’t let nature take its course. She hesitated and then explained that her daughter would be getting married in 4 months to her cousin who is older by 10 years, and that he has been working in Lebanon and has a stable place to live. The mother further elaborated that the registration process with the United Nations would speed up if her daughter became pregnant. This meant a guarantee of food coupons and other benefits for the family.

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