CASE: 19-year old male was admitted to a trauma service after falling from a height of 20 feet while rope climbing during military basic training activity. He climbed to the top of the rope but was unable to navigate a series of other activities at the top, became distracted, and fell. He sustained superficial injuries but was admitted to the hospital for observation. An Adolescent Medicine consult was obtained consistent with the trauma service protocol. During that consultation, a comprehensive past medical history was initially negative. On further inquiry however, when asked “Are you supposed to take any medications?” the patient revealed that several years earlier he was diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Medication at that time was associated with improvement in school performance. He progressed from being a poor student to successfully completing freshman year at college prior to enlistment. He knew medication for ADHD would prevent enlistment, so he did not reveal the disorder or medication to his recruiter. While obtaining this history the patient was talkative, easily distracted and admitted that his concentration and ability to follow instructions was significantly enhanced on medication.
For a consultant, the dilemma became how to handle this potentially important piece of history. Inability to follow instructions may have contributed to this hospitalization and had the potential to put him and his colleagues in greater future jeopardy. Revealing this history might also cause discharge from the military.
Lawrence S. Friedman, MD, Professor of Pediatrics, Chief, Division of Primary Care, Pediatrics and Adolescent Medicine, University of California, San Diego, CA.
Gregory S. Blaschke, MD, MPH, Assistant Professor of Pediatrics, Naval Medical Center, San Diego, CA, University of California, San Diego, CA, Uniformed Services University, Bethesda, MD.
Warren P. Klam, MD, MSMM, Senior Medical Officer, Chairman, Psychiatry, Directorate of Mental Health Services, Naval Medical Center, San Diego, CA.
Martin T. Stein, MD, Director of Developmental and Behavioral Pediatrics, University of California, San Diego, CA, Children's Hospital, San Diego, CA.