A 16-year-old girl comes to the office for an initial patient visit. Medical conditions include asthma and mild acne. The patient maintains a B+ average at school. She does not smoke or use illicit drugs regularly but has tried alcohol and marijuana at parties a few times. She is not sexually active. When asked about extracurricular activities, the patient confides that she is thinking about quitting her high school softball team because "the other girls are mean, and I just don't enjoy playing anymore." When asked to describe how she feels, she hesitantly mentions that she gets depressed at times and frequently feels self-conscious and that no one likes her. The patient appears uncomfortable and nervously asks the physician. "You won't say anything about this to my parents, will you?" Which of the following is the most appropriate response to the patient?

Question

A 16-year-old girl comes to the office for an initial patient visit.  Medical conditions include asthma and mild acne.  The patient maintains a B+ average at school.  She does not smoke or use illicit drugs regularly but has tried alcohol and marijuana at parties a few times.  She is not sexually active.  When asked about extracurricular activities, the patient confides that she is thinking about quitting her high school softball team because "the other girls are mean, and I just don't enjoy playing anymore."  When asked to describe how she feels, she hesitantly mentions that she gets depressed at times and frequently feels self-conscious and that no one likes her.  The patient appears uncomfortable and nervously asks the physician. "You won't say anything about this to my parents, will you?"  Which of the following is the most appropriate response to the patient?

Quizplus · Accepted Answer

Protecting the adolescent's confidentiality is important to maintaining a trusting physician-patient relationship and establishing an atmosphere of safety in which the adolescent feels comfortable discussing sensitive issues such as mental health, drug use, and sexuality. Adolescents are often unclear about the limits of confidentiality and are more likely to disclose sensitive information if the physician makes an explicit statement regarding confidentiality and its exceptions. Adolescents should be informed that everything they discuss will be kept private with a few exceptions as required by law. Although state laws may vary to the extent which they protect the confidentiality of minors, most include the following exceptions: self-injurious or suicidal behavior, homicidal ideation, abuse, and neglect. Adolescents should also be informed that certain sexually transmitted diseases are reportable to public health departments. (Choice A) It is misleading to assure the adolescent patient of unconditional confidentiality. Situations involving risk of self-harm, homicidal ideation, or abuse require disclosure to the parents and/or state protective agencies. (Choices C and D) The physician is not obligated to keep the parents informed or to respond to questions about what the adolescent discusses. The patient's confidentiality can be maintained if there are no exceptions. (Choice E) The Health Insurance Portability and Accountability Act (HIPAA) does not ensure unconditional confidentiality for adolescents. HIPAA allows a physician to disclose information to a parent if required by state law. Educational objective: Having an explicit discussion about confidentiality and its exceptions is important to maintaining a trusting physician-patient relationship with adolescents. They should be informed that everything they discuss will be kept private with a few exceptions as required by law, which include suicidal or homicidal ideation, abuse, and neglect.

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