The Issue of Patient Confidentiality
Your role as child or adolescent health care provider should be to advocate for the best health possible for your patients and their families. As an advocate, you will need to make decisions about when to involve parents in the care of your adolescent and young adult patients. Adolescents have the legal right to receive confidential services for substance abuse, mental health and reproductive health. Some patients may be sufficiently involved in substance abuse or other risky behaviors that involvement of their parents may be appropriate. Deciding when to involve parents requires sensitivity to the specific behaviors and associated health problems, and his or her willingness to work with the provider.
For those patients who are sufficiently involved in severe or health threatening behavior and who express an unwillingness to work appropriately with the provider at improving their behavior-related health status, parental involvement is necessary. Before taking any action, however, the health provider should inform the patient of his or her concerns and intention to involve the parents. Since drug users at every age frequently deny that their functioning has been affected even when the impairment is obvious, there is the distinct possibility that your position on disclosure will class you with other adults as an adversary. This is a risk that must be taken in the long-term interests of your patients well being and to fulfill your professional role.
Some physicians who provide primary care to children have found that scheduling family sessions from time to time in which parents can discuss their childs health and any problems in child rearing they are experiencing can be important in building a professional relationship with them and with their child. It also helps to communicate your desire to encourage their childs healthy development in any way you can. Such conferences can be useful at 6 weeks after birth, about age 2, just before the child enters school, before adolescence, during the high school years and possibly just after high school graduation. They can provide an opportunity for an unhurried discussion of child health issues, including the need to develop a firm parental stance against the use of alcohol and other drugs. Knowing that you are available for a longer conference on a regular basis (if one is needed) may also make the parent (and your patient) more willing to bring up problems that cannot be adequately dealt with in a brief routine visit.