American College of Pediatricians (ACPeds) Urges Physicians: Strive to Bridge Parent-Child Communication Adolescent Confidentiality Notwithstanding.
17 September, 2020
Quentin Van Meter, MD, FCP, President
Adolescents are helped to mature when adults give them appropriate responsibility in decisions that affect their lives. However, because teenagers are still in the process of maturing, they benefit from parents who foster a high level of connectedness, convey clear values, and monitor their activities in age-appropriate ways. Consequently, adolescent confidentiality in pediatrics should be practiced in a way that fosters parent-child communication rather than undermines it.
Pediatricians have long been instructed to introduce the concept of adolescent confidentiality during the 11-year-old well-care visit. After reviewing nonconfidential information with the parent and child in the examination room, it is recommended that the doctor ask the parent to return to the waiting room so that the pediatrician can spend time alone with the child. The purpose is not only to conduct the physical exam in private, but also to review sensitive questions with the child, most commonly about smoking, drug and alcohol use, sexual activity, gender identity, and mental health; questions, it is presumed, the child might not feel comfortable answering in front of the parent.
Although ACPeds recognizes that adolescents might benefit from time alone with their pediatrician, it calls attention to the fact that this may undermine the parents’ right and responsibility regarding their minor child’s welfare and weaken the parent-child bond. Adolescent confidentiality may not serve the best interest of all adolescents all of the time—particularly if the health goals and values of competent parents are undermined in the process.
ACPeds therefore encourages physicians not only to abide by governing state laws but also to offer a one-on-one conversation with the adolescent in a way that does not alienate parents. Dr. Jane Anderson, board member of ACPeds and retired faculty in Pediatrics at UCSF, would offer the following information to the patient and parent before speaking individually with the adolescent:
“I like to have some one-on-one time with all my teenage patients because I think it is important for them to start taking responsibility for their own health care. If you are comfortable having a one-to-one talk with me, I’d like to do that as part of today’s visit.
However, I like to keep parents in the loop as much as possible because of how important I think parent-teen communication is. After the two of us talk, I’d like us to bring your parents up to speed on what we discussed; okay? If there was something you told me that you feel is hard to talk about with your parents, I can help you with that. That’s what I’m here for. So please let me know. (If state law protects adolescent confidentiality, then that too should be clearly explained to both parent and child at this time).”
By offering to actively facilitate what might be a challenging family conversation, the pediatrician not only clearly demonstrates a desire to help parents and adolescents bridge the communication divide, but also increases the chances that such a conversation will actually occur. Of course, if the adolescent insists on patient confidentiality once alone, the pediatrician should respect this in accordance with governing state laws. In this case, it is also important to realize that some adolescents are reluctant to speak with their parents because they are experiencing abuse in the home. Every effort should be made to identify whether or not this is the case, and if it is, to notify child protective services.
You can read the full statement here: https://acpeds.org/position-statements/adolescent-confidentiality
About the American College of Pediatricians
The American College of Pediatricians (ACPeds) is a national medical association of licensed physicians and healthcare professionals who specialize in the care of infants, children, and adolescents. It was founded by a group of concerned physicians who saw the need for a pediatric organization that would not be influenced by the politically driven pronouncements of the day. The mission of the ACPeds is to enable all children to reach their optimal physical and emotional health and well-being. The ACPeds is committed to fulfilling its mission by producing sound policy, based upon the best available research, to assist parents and to influence society in the endeavor of childrearing.