A 16-year-old boy is brought to the office by his mother for follow-up after sustaining a ligament injury while playing football 4 weeks ago. The patient has been using a splint and going to physical therapy twice weekly. His pain has decreased, and he is hoping to return to football practice. Medical history is significant for asthma managed with as-needed albuterol and prior treatment of gonorrhea, which he acquired a year earlier after an unprotected sexual encounter. Physical examination of the ankle reveals no pain, tenderness, or swelling and there is full range of motion. At the end of the visit the mother mentions that the family is moving to a new neighborhood and will be changing medical providers. She asks for a copy of her son's medical record to take to the new practice. Which of the following is the best response to the mother's request?

Question

A 16-year-old boy is brought to the office by his mother for follow-up after sustaining a ligament injury while playing football 4 weeks ago.  The patient has been using a splint and going to physical therapy twice weekly.  His pain has decreased, and he is hoping to return to football practice.  Medical history is significant for asthma managed with as-needed albuterol and prior treatment of gonorrhea, which he acquired a year earlier after an unprotected sexual encounter.  Physical examination of the ankle reveals no pain, tenderness, or swelling and there is full range of motion.  At the end of the visit the mother mentions that the family is moving to a new neighborhood and will be changing medical providers.  She asks for a copy of her son's medical record to take to the new practice.  Which of the following is the best response to the mother's request?

Quizplus · Accepted Answer

Protecting adolescent confidentiality is critical to maintaining open communication between the patient and physician regarding sensitive issues (eg, sexuality, mental health, substance use) and can significantly impact an adolescent's willingness to seek future health care. Adolescents have the right to consent for treatment of sexually transmitted infections (STIs), and this information is considered confidential. In this situation, transfer of the medical record to the parent may inadvertently violate the patient's confidentiality regarding his treatment for gonorrhea. Rather than providing a copy to the parent, the patient's medical record can be transferred directly to the new provider. In this way, the mother's desire to ensure continuity of care is respected and the patient's confidentiality is not compromised. (Choices A and B) Although the medical record is the property of the clinic, it is in the best interest of the patient to share information with new providers or specialists and inappropriate to decline the parent's request. The adolescent's confidentiality can be maintained by having the medical record transferred directly to the new provider. (Choice D) Although redacting the record is a possibility, the mother has requested a copy of the record to facilitate continuity of care. Providing her with only nonconfidential information would maintain confidentiality but fail to adequately ensure continuity regarding the entirety of the patient's treatment history. (Choice E) The mother does not have the right to the patient's entire medical record because confidentiality regarding treatment of STIs should be maintained. Educational objective: Adolescent confidentiality regarding sensitive issues, including treatment for sexually transmitted infections, mental health concerns, and substance use, should be protected. When transferring care, it is preferable to provide the medical record directly to the new provider rather than providing a copy to the parent. References: Confidentiality, consent, and caring for the adolescent patient. (http://www.ncbi.nlm.nih.gov/pubmed/19474734) Sexually transmitted infections in adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/23530381) I thought you said this was confidential?-challenges to protecting privacy for teens and young adults. (http://www.ncbi.nlm.nih.gov/pubmed/29309491)

A 16-Year-Old Boy Is Brought to the Office by His