Confidentiality, consent, and caring for the adolescent patient

Berlan, Elise D.; Bravender, Terrill

doi:10.1097/mop.0b013e32832ce009

Cited by 108 publications

(68 citation statements)

References 48 publications

(56 reference statements)

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“…In addition, while Title X clinics are legally required to safeguard the confidentiality of minors seeking services there, the scope of the services they can provide without parental consent may be limited by the same state laws that apply in Dr. Carson's office. This is an area of the law that is both unclear and evolving [2,22].…”

Section: Alex Responds Angrily "I'll Come Back Tomentioning

confidence: 99%

“…Because many adolescent patients see their primary care physicians infrequently and at those times for acute matters only, opportunities to provide preventive health care can be few and far between [2,4]. In our clinical case scenario, Alex has come to Dr. Carson for a physical exam.…”

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confidence: 99%

“…"Time alone" has been shown to significantly increase the likelihood that adolescents will discuss sensitive health matters and is generally supported by parents and appreciated by patients [1][2][3].…”

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confidence: 99%

“…By providing Alex an opportunity to discuss matters privately, Dr. Carson follows a recommended practice for gaining the trust of adolescent patients-a practice that is supported by ethical principles, legal analyses, and research findings [1,2]. "Time alone" has been shown to significantly increase the likelihood that adolescents will discuss sensitive health matters and is generally supported by parents and appreciated by patients [1][2][3].…”

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confidence: 99%

“…Note that as the conversation progresses, Dr. Carson misses an opportunity to find out what Alex has discussed with her mother and how they should bring her mother into the discussion. Recognizing and negotiating this tripartite relationship is critical to best practices for adolescents [1,2].…”

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confidence: 99%

See 4 more Smart Citations

The HPV Vaccine and Parental Consent

Chen

Shepherd²,

Becker³

2012

AMA Journal of Ethics

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Section: Alex Responds Angrily "I'll Come Back Tomentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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The HPV Vaccine and Parental Consent

Chen

Shepherd²,

Becker³

2012

AMA Journal of Ethics

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Analysis of Reported Health Care Use by Sexual Orientation Among Youth

et al. 2021

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IMPORTANCEIn the United States, adolescents who are lesbian, gay, or bisexual (LGB) face disparities across physical and mental health outcomes compared with non-LGB youth, yet few studies have looked at patterns of health care utilization by sexual orientation. OBJECTIVE To compare health care utilization indicators for LGB and non-LGB youth. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed wave 3 data from Healthy Passages, a longitudinal observational study of diverse public school students in Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Multivariable logistic regression models tested sexual-orientation differences in the past 12-month health care utilization measures, controlling for youth age, gender, race and ethnicity, household education, income, and marital status. Data collection began in 2010 when students were in the 5th grade (mean [SE] age, 11.13 [0.01] years) (wave 1) and continued 2 years later (wave 2, 7th grade) and 5 years later (wave 3, 10th grade). Permission to be contacted was provided for 6663 children, and 5147 (77%) participated in audio computer-assisted self-administered interviews. This study included 4256 youth (640 LGB, 3616 non-LGB) who completed interviews at wave 1 and wave 3 and answered key items used in this analysis. Analyses were completed in June 2021. EXPOSURES Sexual orientation (LGB vs non-LGB).MAIN OUTCOMES AND MEASURES Health care utilization and communication difficulty with a physician in the past 12 months. RESULTS Among 4256 youths included in the study at baseline in 5th grade (wave 1), 2171 (48.9%) were female; 1502 (44.5%) were Hispanic or Latino; 1479 (28.9%) were Black; the mean (SE) age was 11.19 (0.03) years; and 640 (14.5%) were LGB at wave 3. Compared with non-LGB youth, a higher proportion of LGB youth reported not receiving needed medical care in the last 12 months (adjusted odds ratio [aOR], 1.68; 95% CI,1.38-2.05), most commonly for sexually transmitted infections, contraception, and substance use. LGB youth more frequently reported difficulty communicating with their physician (aOR, 1.71; 95% CI, 1.27-2.30) than non-LGB youth.CONCLUSIONS AND RELEVANCE This study's results found that health care utilization differs by sexual orientation for youth. These findings suggest that clinician training is needed to address the health care needs of LGB youth. Routinely capturing sexual orientation data might enable tracking of health care utilization indicators for LGB youth.

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Protecting the Confidentiality of Sexually Active Adolescents

Santos

2012

AMA Journal of Ethics

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CLINICAL CASE Protecting the Confidentiality of Sexually Active AdolescentsCommentary by Xiomara M. Santos, MD Dr. Nelson was just about to leave the office for the day when her pager went off. She returned the call, and learned that one of her patients, Andrea, was in the emergency room with what looked like pelvic inflammatory disease (PID). Dr. Nelson sighed. She had placed an intrauterine contraceptive device (IUD) for Andrea in the office last week, and the PID could be a rare complication of the procedure.Andrea had come to the appointment last week by herself. She said that she had recently become sexually active with her boyfriend, and she really didn't want to get pregnant. Although Andrea was only 15, laws in her state allowed her to legally consent to contraceptive services. After reviewing Andrea's history and doing a physical exam and pregnancy test, Dr. Nelson found no medical contraindications to an IUD. Dr. Nelson counseled Andrea about the risks and benefits of the IUD and alternative methods. Andrea and Dr. Nelson agreed that the IUD was the best option.When Dr. Nelson arrived in the emergency department, she was dismayed to hear yelling coming from Andrea's room."You're going to tell me that this isn't because you were having sex? Well, we'll see what the doctors have to say about that! You're my daughter and I'm not going to have you living under my roof if you're sleeping with that boy!" Hoping that she could defuse the situation, Dr. Nelson headed into the room. She was met by an angry man who said he was Andrea's father. "What's going on here?" he shouted. "This is because she had sex, right? Well, if she did, she's out of my house for good!" He stormed out.After her father left the room, Andrea pleaded with Dr. Nelson not to tell him that she was sexually active. She said that his threat was real-he'd forced her older sister to leave home when she got pregnant at age 18. Andrea said that things at home were fine and that she and her father had always gotten along well, but that he had made it clear that he believed his daughters should wait to have sex until they were married. "Even if you don't say anything, he's going to think this is because I'm having sex," Andrea insisted. "Can't you just make up another reason why I'm sick?"

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Confidentiality, consent, and caring for the adolescent patient

Cited by 108 publications

References 48 publications

The HPV Vaccine and Parental Consent

The HPV Vaccine and Parental Consent

Analysis of Reported Health Care Use by Sexual Orientation Among Youth

Protecting the Confidentiality of Sexually Active Adolescents

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