Challenges of Providing Confidential Care to Adolescents in Urban Primary Care: Clinician Perspectives

M. Diane McKee; Susan E. Rubin; Giselle Campos; Lucia F. O’Sullivan

doi:10.1370/afm.1186

Published eLetters

If you would like to comment on this article, click on Submit a Response to This article, below. We welcome your input.

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

Vertical Tabs

Jump to comment:

The challenges of providing confidential care to teens
Christopher V. Chambers

Published on: 30 January 2011
Removing obstacles to confidential care of adolescents
Mark E. Horowitz

Published on: 26 January 2011
Confidentiality for Youth in Primary Care Key to Developmental and Health Issues
JoAnn Elizabeth Leavey

Published on: 24 January 2011

Published on: (30 January 2011)

The challenges of providing confidential care to teens
Christopher V. Chambers, Philadelphia, PA USA
I was impressed with the sophistication of the clinicians who participated in this study and their management of adolescent patients and their parents. This article will provide a good basis for discussion with our residents who are developing their own strategies for providing comprehensive care to adolescents in a time-constrained practice environment.
Family physicians have a tremendous opportunity to facilit...
Show More

I was impressed with the sophistication of the clinicians who participated in this study and their management of adolescent patients and their parents. This article will provide a good basis for discussion with our residents who are developing their own strategies for providing comprehensive care to adolescents in a time-constrained practice environment.
Family physicians have a tremendous opportunity to facilitate the transition from childhood, where the parents provide all of the relevant history at a visit, to adolescence, where the parent and child often have different agendas to discuss with the clinician.
The qualitative comments regarding many parents' readiness to leave the room to allow confidential time with the doctor are consistent with my own experiences. It is unusual for a parent to resist leaving but when it occurs, the circumstance is typically a "new referral" where the interaction between the parent and teen is already emotionally charged.
Competing interests: None declared
Show Less

Competing Interests: None declared.
Published on: (26 January 2011)

Removing obstacles to confidential care of adolescents
Mark E. Horowitz, New York, USA
This study is satisfying in its reassurance that many of our colleagues place enough importance on the provision of confidential care to adolescents that they take the added time from their busy schedules to meet individually with their adolescent patients, even when those patients are accompanied by a parent.
While the method used to assess clinician practices has limitations (the card method relies upon recall...
Show More

This study is satisfying in its reassurance that many of our colleagues place enough importance on the provision of confidential care to adolescents that they take the added time from their busy schedules to meet individually with their adolescent patients, even when those patients are accompanied by a parent.
While the method used to assess clinician practices has limitations (the card method relies upon recall and self-report), it appears that 2 in 3 clinicians surveyed adhere to a practice standard that recognizes the value of meeting individually with a young adult patient.
I was particularly impressed with many of the comments garnered from participants in the study. It's reassuring to know that many of my colleagues really recognize the importance of providing confidential care to adolescents.
Competing interests: None declared
Show Less

Competing Interests: None declared.
Published on: (24 January 2011)

Confidentiality for Youth in Primary Care Key to Developmental and Health Issues
JoAnn Elizabeth Leavey, London, Canada
I am in concurrence with authors regarding the direction in primary care to provide "alone time" for adolescents and youth with clear criteria. The important points stressed in this article regarding confidentiality issues are worthy of reiteration for clinicians dealing with this population.
Confidentiality guidelines and policies need to be clear, consistent and discussed with each patient/parent dyad, requi...
Show More

I am in concurrence with authors regarding the direction in primary care to provide "alone time" for adolescents and youth with clear criteria. The important points stressed in this article regarding confidentiality issues are worthy of reiteration for clinicians dealing with this population.
Confidentiality guidelines and policies need to be clear, consistent and discussed with each patient/parent dyad, requiring "alone time". It is important to utilize this opportunity to ensure that both the young person and the parent understand the benefits and the limitations of confidentiality. For example, harm to self or others would preclude confidentiality, as the clinician would be tasked to take action under certain circumstances in compliance with their respective state/provincial Mental Health Act.
Further, although alone time may be a necessary element to assist young people in disclosing difficult issues such as teen pregnancy, sexually transmitted diseases and mental health and addiction problems, it is important, as the authors point out, to perhaps have the clinician play a mediator role to include parents where practicable. This approach could potentially assist both the young person and their parent(s) to build discussion around education regarding the issue, and emotional support in handling the situation and subsequent intervention(s).
Difficult issues can be challenging for young people to raise with their parents on their own. Therefore, training and education for clinicians will be a key factor in their success when facilitating adolescent-parent communication by way of a mediator/educator role in primary care.
Competing interests: None declared
Show Less

Competing Interests: None declared.