By: Dr. Cynthia Mollen
I watched the young woman walk into the exam room with the nurse. I noticed that she looked uncomfortable, so I went right in to see her.
“What’s going on?” I asked.
The nurse gave me the basics, “She’s been having abdominal pain since last night. She’s feeling nauseous. No fever.”
After getting the patient’s vital signs – temperature, blood pressure, and pulse – the nurse left me alone with the young woman and her mother. I asked some basic questions to fill in more details about why the patient had come to the Emergency Department (ED). I then addressed both of them, as I do for all teen patients I care for in the ED.
“Mom, I’m going to ask you to step out for a few minutes so I can talk to your daughter alone. I spend time one-on-one with all teens. First, I do this because it’s important for teens to learn how to talk to their medical team on their own. Second, sometimes there are things a teen is more comfortable discussing without a parent in the room. Everything she and I discuss is confidential – just between us – unless she tells me she wants to hurt herself, hurt someone else, or someone is hurting her.”
Usually, the parent voluntarily steps out, and I can have my private conversation with the patient. More rarely, a caregiver says they don’t want to leave. In those cases, we talk more about why doctors talk privately with teens and I answer questions from the caregiver. More often than not, the caregiver gives us some time. As the parent of two teenage daughters, I understand parents’ concerns about a stranger talking with their child. As a doctor, I understand that making the right diagnosis and helping young people to learn the skills for managing their health depends on them having this private time.
During my confidential interview, I ask a range of questions – from how the patient is doing in school, to what activities they like. I ask about suicidal thoughts. I ask if the teen feels safe at home, school, in romantic relationship, and with their friends and peers. I ask about eating behaviors, sexual activity, drug and alcohol use. I ask these questions to all teen patients, no matter what their reason for coming to the ED.
As children go into their teen and young adult years, they are much less likely to see a health provider regularly. A surprising number of teens only encounter with the health care system during emergency room visit. So, this might be the only opportunity health providers like me have to address critical health issues like depression, anxiety, abuse, safe sexual activity, or risky behaviors.
Medical organizations, such as American Medical Association (AMA) and the American Academy of Pediatrics (AAP) recommend that health providers who care for teens provide private, confidential care. Parents should know that the majority of teens are healthy and are not sexually active, using illegal substances, and don’t have a mental health condition. But, teens who are at the greatest risk of harm – whether it be due to binge drinking, unsafe sex, or suicide – are more likely to discuss these issues with a health provider when they feel confident that their discussions are private.
Although it is recommended that all health providers talk with teens privately, all too often, teens are not given the opportunity to speak alone to a provider, particularly in the ED. Parental caregivers and patients, should expect that this will happen and advocate for it if a provider does not offer to do it. It doesn’t matter you think your daughter or son has a stomach bug, the flu, or a sexually transmitted infection.
Giving them a chance to discuss their symptoms and any concerns they may have today will help them to talk confidently with their health provider in the years to come.
Talk with your adolescent to know the following:
- Talk with your young person so they know why it is important to have confidential medical services
- Talk with your young person so they can begin to feel empowered about talking to their doctor alone
- Talk with your young person so they know their rights