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Teens to their docs: Can we talk (confidentially)?

What does the law say about doctor-teen patient confidentiality and consent? Also, here are some tips to help parents communicate more openly with their teen about sexual health.

As an adolescent medicine doctor, I sometimes find myself caught between a rock and a hard place: in between my teenage patients and their parents. Despite trying to encourage them to talk openly with their parents, sometimes it's just not gonna happen. And nine times out of ten, it has to do with sexual health.

I hear their concerns:

  1. If my parents find out that I had sex, they will be really disappointed in me.

  2. If my pregnancy test is positive, do you have to tell my mom?

  3. My parents will kick me out of the house if I get pregnant.

  4. Can I get tested for sexually transmitted infections (STIs) without my parents finding out?

  5. I got Gardasil (vaccine against Human Papilloma Virus) and my mom is furious because she didn't give permission.

Other teens may also be on the "no parents" team. As a parent, I admit that this is a hard pill to swallow. In fact, many teens would not get the medical care they needed if their parents had to know:

  1. In a survey of 649 adolescents, fewer than 20 percent would seek care related to birth control, STIs, or drug use if their parents had to be notified.

  2. In a study of 950 adolescent girls, 59 percent would stop using sexual health care services if there were mandatory parental notification.

What does the law say about doctor-teen patient confidentiality and consent?  If a medical care provider has family planning services supported by the federal Title X program, then teenage confidentiality is strongly protected. Outside Title X, laws vary depending on the state:

  1. Contraceptive services: 26 states (including Pennsylvania) allow minors to consent to contraceptive services.

  2. STI services: All states allow minors to consent to STI prevention and treatment services.

  3. Prenatal care: 32 states (including Pennsylvania) allow minors to consent to prenatal care.

  4. Adoption: 28 states (including Pennsylvania) allow minors to place children up for adoption; 5 states (including Pennsylvania) require parental notification.

  5. Medical care for a minor's child: 30 states (including Pennsylvania) allow minor parents to consent to medical care for their children.

  6. Abortion: 21 states (including Pennsylvania) require that at least one parent to consent to a minor's abortion.

Worst-case scenario: It happened to one of my patients. She went on the birth control pill to prevent an unwanted pregnancy. A few months later, her father discovered her pills, got rid of them, and forbade her from having sex. A few months after that, she had a positive pregnancy test.

Now, can we talk? Facts are facts; whether parents approve or not, about half of teens have had sex by the time they graduate from high school. One thing that we can do to help our adolescents delay the onset of their sexual activity is to open up the channels of communication. Explain why we prefer that they wait. Contrary to popular opinion, research shows that when it comes to factors that influence teens' decisions about sex, more than half (53 percent) of teens said that their parents as well as their own morals, values and/or religious beliefs have the most influence. By contrast, few teenagers said that friends, the media, or teachers and sex educators have the most influence. Similarly, most teens (69 percent) said that it would be easier for them to postpone sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations with their parents about these topics.

Best-case scenario: Teens and their parents communicate openly about these issues and are on the same winning team.

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