Recently a colleague told me about an encounter that left me thinking, ‘as Pediatricians, we really need to do a better job of explaining confidentiality!’ They were seeing a teen for a follow up visit and had asked the medical assistant to put the patient in room without the parent. The parent became very upset that their 18 year old was seeing the provider alone and complained to the front desk staff in the clinic. From my perspective, as an provider who specializes in adolescent health, rooming an 18 y/o without their parent seemed like standard practice. But what was neglected was the explanation to the teen AND their parent about why this is done. As a parent myself, I can empathize with the frustration the parent likely felt. They came to the appointment with their teen, they’re likely going to receive the office bill and pay it, and the teen lives with them, so they are likely very involved in the youth’s life. So why is confidentiality and the opportunity for teens to visit with their health care providers important?
First let’s start by defining confidentiality. If you ‘google’ the definition, you get the response …the state of keeping or being kept secret or private. I explain it this way to parents and teens: we speak alone for a bit to give you/your teen an opportunity to practice autonomy. What we discuss will stay between us unless I’m concerned about safety.
In every state and the District of Columbia, there are confidentiality laws in place that protect the rights of adolescents to receive certain services without parental permission. Examples include access to reproductive health services like sexually transmitted infection screening and birth control, mental health treatment, and substance abuse treatment. These laws are in place to ensure teens have access to care if they have parents who are unsupportive, in situations of abuse, and to encourage teens to actually come in for treatment. Research shows time and time again that what teens value most in a provider is trust. If they don’t trust that the health care provider can see with confidentially and without judgment, they’re much less likely to come in for care.
Here are some questions parents often ask me:
Does confidentiality mean that the parents are automatically ‘kicked out’ of the doctor patient relationship? Of course not! Teens are not independent adults (yet). They need the opportunity to practice speaking about health care concerns, but they also still need their parents to help them navigate the complicated world of medical care, guide them in making often hard decisions about their bodies, and support them during health care visits. Every pediatric provider I know and work with wants parents to be involved in the care of their teens.
When will my doctor ask to speak with my child alone? In general, most providers will start to speak with a child alone once they start middle school. This varies, but the American Academy of Pediatrics (AAP) and the Society for Adolescent Health and Medicine (SAHM) recommend providers do spend time speaking confidentially with teens. I ask all parents to step out for a few minutes, though most of my patients are age 12 or older.
Will I be able to talk with the doctor in private too? I try to give parents an opportunity to speak with me in confidence too. I want to hear parent perspectives and sometimes parents have things they’d like to tell me in private (for example, discussing a behavior that may be embarrassing for a teen or if they have a significant concern they want to be certain I’m aware of). If we run out of time, I offer parents the chance to call me with concerns. Though I may not be able to tell a parent every detail of what their teen said to me, I can offer a listening ear.
Does confidentiality mean important information will be withheld? If I am concerned about a teen’s safety, I break confidentiality. As soon as their parents leave the room, I let every teen know that I will need to speak to a parent (or adult caregiver) if I’m worried about them. If a teen tells me something that puts them at risk for serious harm, I remind them that I will need to tell an adult. There are often times when we bring parents back into the conversation, even if information does not fall into the boundaries of confidentiality laws, but the teen needs more support. I offer to help share the information in a way that is comfortable for the teen: tell their parents the situation in a different room, be present while they tell their parent, or speak with their parents while they sit quietly in the room.
I hope this information shed a bit of light on why teens need the opportunity to speak confidentially with their health care providers. Do you have advice for pediatricians on how to address confidentiality? Have you been asked to step out of the room at a doctor’s visit? If so, was it anticipated or did it take you by surprise?
If you’d like to read more check out this story from NPR.