USMLE® Board Review Exam Apps & Resources

A 12-year-old girl is brought to the clinic by her parents for evaluation of decreased exercise tolerance and increased lethargy. Her parents say she becomes short of breath with minimal exertion, and for the past 2 weeks her gums have bled when she brushes her teeth. Temperature is 36. 7 C (98 F); blood pressure and pulse are normal. Physical examination demonstrates pallor and hepatosplenomegaly. An extensive workup indicates that the patient has acute lymphoblastic leukemia, and the parents are informed that she will need chemotherapy. The parents do not consent to the treatment plan because they believe that the side effects will be too severe and that their child's quality of life will be poor. Despite an ethics consultation and a lengthy discussion about the benefits of treatment and likely consequences if therapy is withheld, the parents insist on taking her home without scheduling follow-up treatment. Which of the following is the most appropriate next step in the management of this patient?