doctor and patientMost parents are expecting it: that day when your health care provider politely asks you to leave the room so they can speak to your tween or teen alone. It’s a rite of passage, an acknowledgment that teens might have events or concerns that they don’t feel comfortable talking over with family members present.

I’ve gotten a few amused comments, such as, “It’s time for the sex talk!” as well as some dissent. I wanted to write a bit about what we talk about while you’re gone, and why it’s important.

Sex You knew that one. Many teens do not want anything sexual discussed with family in the room. If your teen is sexually active, both you and your provider would probably love it if they’d communicate openly with their family. However, teens often underestimate their parents’ willingness and ability to go over this topic. They imagine that their parents are so inexperienced and stodgy that they’d fall over if they heard words related to sex coming out of their teen’s mouth. When they are more mature, they will be able to acknowledge, to your face, that sex exists and both of you have engaged in it. For now, a provider can discuss safety- both physical and emotional- as well as good decision-making, pregnancy prevention, and communication with partners. Note that sex talks aren’t always because a teen is sexually active; they may be thinking about it, wondering for the future, or just checking in to make sure their desires and concerns are normal.

Drugs. We know some teens experiment with drinking and drugs, and the vast majority of parents would rather they didn’t. Many teens are convinced they would be grounded for life if they talked to their parents about it. Providers can’t punish a teen, and by Washington state law can’t share drinking or drug concerns without a teen’s permission. This creates a feeling of relative safety, where providers can start open conversations. If teens have a problem, providers can work with them on how to get their family involved so they can get the help they need.

Rock n’ roll. Okay, I’m just kidding about this one. Most conversations I have with teens about music end up with them staring at me in horror, although it is nice to meet the occasional Pink Floyd fan.

Body image and basic biology. Tweens and teens are intensely curious about their bodies, and may be relieved to be able to ask  personal or embarrassing questions. Peers, the internet, and other unreliable sources may give them astonishingly incorrect information; providers can correct it, and make sure teens know the truth about their and others’ bodies. “Am I normal?” is a huge question looming in the minds of most teens, and providers can often put their minds at rest when they’re convinced their body is different, weird, subpar, or wrong.

Disturbing health concerns. Sometimes teens have physical or mental concerns they don’t want to bring up in front of family, because they don’t want to worry them. This is especially true for teens whose families are stressed, struggling, or already dealing with another illness. We think of teens as impolite and self-centered, but many of them will go to great lengths to spare their family pain. Providers can often reassure them, or put their concerns in perspective, before helping them share with their family.

Relationships. A lot of teens don’t want to talk to their family about the negative aspects of their romantic relationships, because they want approval of their partner. Health care providers can be a good sounding boards for relationship problems, and how to deal with them. Dating violence is a real problem for today’s teens, and providers always have radar up for worrisome signs.

This isn’t an exhaustive list; there are many topics that might be touched upon when providers talk to teens alone. Recently I spent time alone with a teen talking not about sex or drugs, but about a family member’s substance abuse and her conflicting feelings about it.

Privacy is part of becoming an adult, and hopefully you can support your teen having alone time with a provider, even though it might be hard the first few times.

I also want to call out what providers can’t- and don’t want to- keep confidential. If teens are at risk for suicide, hurting someone else, or are being physically or sexually abused, families will be notified and the appropriate steps taken to keep everybody safe.

For providers, what else do you talk about with teens during these sessions? For families, what do you remember from this as a teen, and what would you hope for your teen’s experience?