A 16-year-old girl comes to the office for an annual checkup, accompanied by her mother. The patient is a junior in high school and lives with her parents and 2 younger siblings. During the visit, she discloses that she has had sexual intercourse several times with a boy in her class. The patient believes she may be in love and says that the sex is consensual. Her partner is using condoms. When the physician inquires if her parents are aware that she is sexually active, the patient says, "I would never tell them. They are totally against premarital sex. They don't even allow me to date. They would be furious if they knew." Physical examination is normal and urine pregnancy test is negative. Routine laboratory screening for common sexually transmitted diseases is performed, and the patient is educated about safe sex and contraceptive options. The patient asks the physician to say nothing to her parents.
Which of the following is the most appropriate response to the patient?

Question

A 16-year-old girl comes to the office for an annual checkup, accompanied by her mother.  The patient is a junior in high school and lives with her parents and 2 younger siblings.  During the visit, she discloses that she has had sexual intercourse several times with a boy in her class.  The patient believes she may be in love and says that the sex is consensual.  Her partner is using condoms.  When the physician inquires if her parents are aware that she is sexually active, the patient says, "I would never tell them.  They are totally against premarital sex.  They don't even allow me to date.  They would be furious if they knew."  Physical examination is normal and urine pregnancy test is negative.  Routine laboratory screening for common sexually transmitted diseases is performed, and the patient is educated about safe sex and contraceptive options.  The patient asks the physician to say nothing to her parents. 
Which of the following is the most appropriate response to the patient?

Quizplus · Accepted Answer

Explanation: Physicians are instrumental in ensuring that sexually active adolescents have access to health care and counseling services. Protecting the adolescent's confidentiality may be critical to maintaining a trusting physician-patient relationship and establishing an atmosphere of safety in which the adolescent feels comfortable discussing sexuality. Laws pertaining to parental disclosure differ by state, and the physician must be aware of these laws. Some states give the physician the option to disclose issues related to sexual health, mental health, or substance abuse to parents, particularly if the adolescent's health is at risk. Although adolescents should be encouraged to talk with their parents, the physician must use judgment about whether disclosure against the patient's wishes would benefit or harm the patient. If there is reasonable suspicion of child abuse or neglect, or a risk of harm to self or others, the patient's confidentiality should be broken. In this case, the adolescent is practicing safe sex, denies abuse, and asks the physician to maintain her confidentiality. Because there is no evidence of harm and disclosure would likely negatively affect the trusting relationship without clear benefit, the physician should not inform the parents against the patient's wishes (Choice A). (Choice B) Different states have differing requirements regarding parental consent when prescribing contraceptives, and it is possible that parental consent may be required. However, this adolescent has not asked for oral contraceptives, and making this statement so early in the interaction is likely to interfere with building rapport. (Choices C and E) Adolescents should generally be encouraged to involve their parents in their decisions; however, they should not feel pressured to disclose information if they are not ready or willing to do so. This patient has requested that the physician not speak with her parents due to her fear of receiving a harsh and judgmental response. Insisting on disclosure or setting up a meeting with her parents would likely damage the physician-patient relationship and may jeopardize her willingness to confide in health care providers in the future. Educational objective: Physicians should maintain the confidentiality of sexually active adolescents and ensure access to health care and counseling as much as possible. If child abuse is suspected, or if there is a risk of harm to self or others, breaking confidentiality becomes mandatory. References: Adolescents, contraception and confidentiality: a national survey of obstetrician--gynecologists. (http://www.ncbi.nlm.nih.gov/pubmed/21843691) Confidentiality concerns and sexual and reproductive health care among adolescents and young adults aged 15-25. (http://www.ncbi.nlm.nih.gov/pubmed/27996934)

A 16-Year-Old Girl Comes to the Office for an Annual