Q. I recently took my 13-year-old daughter for her checkup and the pediatrician asked to spend part of the visit with just my daughter. It seemed unusual, so I hesitated but eventually relented since he has been taking care of my children for years. I then heard on the news the next week about a bill that would prohibit this. What gives?
A. You (and your pediatrician) did the right thing! There are many reasons that pediatricians and adolescents should spend part of the visit speaking without a parent or guardian present, and it is recommended that this occurs at least once annually. Most families recognize that this is important but often, like you, have some reservations. Many families (understandably) fear that this will be when pediatricians condone risky behaviors that the parents have worked so hard to try to prevent. Other parents (rightfully so) feel that since they know their child best, they would know everything about what their child is doing/thinking about doing.
The American Academy of Pediatrics strongly recommends that adolescents have the opportunity to discuss health care privately with their physician. This gives adolescents an opportunity to take some degree of ownership over their own medical care and helps transition them to young adulthood (hopefully instead of just nodding “yes” or mumbling “no” to a series of questions).
Despite the above fears, pediatricians do not spend time condoning risky behaviors. (Would that make sense? Pediatricians spend time talking to you about the temperature of the water heater. Do we seem like risk-loving people???) We, as pediatricians, fully acknowledge that parents know their children best, and the last thing we want to do is undermine that relationship.
That said, adolescents perpetually fear that their parents “are gonna kill” them. Part of adolescence is attaching more importance to themselves/their actions than exists in reality. Another normal part of adolescence is not accepting that risky behaviors have long-term consequences and that it can (and a certain percent of the time, WILL) happen to them (pregnancy, DWI arrests, accidents while texting). Finally, adolescents often (due to their lack of concept of the future), believe that they can hide things such as pregnancy and drug use from their parents (which will eventually be discovered, regardless, obviously).
We know that when a teen asks for advice about something such as prevention of STDs, simply preaching abstinence, while ideal, will not necessarily prevent them from having sex (for the reasons discussed in the previous paragraph). Thus, while pediatricians are not condoning unsafe behaviors, we can at least counsel teens about the real risks that they (or their friends) are considering taking with the hope that they will modify those plans. Our goal is to involve the parents in these discussions and to help facilitate these in a safe, constructive forum.
By way of example, here are some situations that I have been able to discuss with my teen patients recently that they had not disclosed while their parents were in the room: pregnancy, drug use, depression, suicidal thoughts, sexual assault, unsafe home situations and school problems. So, while none of these things are pleasant to talk about, they can all be more adequately dealt with if a responsible adult is aware.
The right of a teen to seek confidential care for these issues is protected in all states, although this has recently been challenged in North Carolina by a bill introduced in the House. Remember, we are obliged to disclose issues whenever a patient’s safety is jeopardized. If the ability of children to have confidential discussions with their physicians is compromised, our ability to find out about these potential safety issues will be diminished and we will miss out on the opportunity to help the youngsters of our community. Thus, thanks for your positive contribution to your daughter’s medical care!
If you have a question about your child's health or happiness, ask Dr. Eichner or any of our experts by sending email to firstname.lastname@example.org.
Brian Eichner is a general pediatrician and assistant professor of pediatrics at Duke Children's Primary Care-Roxboro Street in Durham. He enjoys providing care for children who are healthy as well as those with complex medical conditions. Dr. Eichner also serves as the medical director of the Duke Pediatric Diagnostic Clinic. He and his wife have lived in the Triangle since 2006.