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A third-year student at an urban teaching hospital is on her pediatrics rotation. One morning she finds that a new patient has been admitted, a seventeen-year old boy who has been transferred from a private hospital in the countryside. The receiving physicians have been alerted that the boy injured himself in a fall, causing potential bleeding to internal organs. The boy, however, does not profess to be in any pain. When his abdomen and other areas are palpated, he gives a forced laugh and says that it tickles.

The third-year student is responsible for checking in each morning with this patient and a resident physician, and then reporting to the team about the boy's condition during" rounds." From the beginning, it is obvious that this patient is not like others. He refuses to allow hospital staff to take his vital signs every four hours (as is customary), and both he and his parents refuse to allow physicians to do any …