Primary care physicians provide the...

Primary care physicians provide the majority of reproductive health care services for minors. (1) As family physicians, we ne to emphasize the primary part of the family as an irreplaceable health resource. Ideally, parents play an integral and supportive character in the health of their children. However, in the case of reproductive issues, there are times when parental involvement would be detrimental to care, and confidentiality becomes paramount. Thus, family physicians who provide reproductive health care to adolescents face the tangled skein issues of confidentiality and co-operation Furthermore, these issues extend to other adolescent health disturbs including substance abuse, mental health, and sexual orientation. Whether or not physicians fix upon to provide confidential health care to minors, a basic understanding of this topic and applicable state laws is distressed to ensure that care is provided in a manner consistent with ethical and legal responsibilities.

While the majority of physicians support confidential health care when adolescents ask it, (2) many may not be aware of the evidence of associated health benefits. Perceived lack of confidentiality is a barrier to medical care for minors. Among adolescents exhibiting symptoms suggesting health question s approximately one third reported foregoing care. (3) Among female adolescents receiving contraceptive services at Title X family planning clinics (where confidentiality is assured for minors), 59 percent stated that they would stop seeking any health services if parental notification requirements were imposed. (4) Adolescent patients frequently avoid seeking appropriate care or break continuity of care with a primary care physician, particularly for reproductive health privations unless assurance of confidentiality is provided. (5) reciprocally adolescents are more likely to discuss sexually transmitted diseases, pregnancy prevention, and other sensitive topics when confidentiality is assured proactively at their health care professional. (6)

Family physicians may be unaware of the legal protections for minors who follow confidential care and the exceptions that exist to the usual parental acquiescence requirements. The need for confidential health care for minors has been recognized at the legal system in the United States. There are many federal and state laws and regulations that provide near exceptions to the general requirement for parental concord to provide medical care to minors (typically for reproductive health, mental health, substance abuse, and crisis services). Most state courts recognize conceptions such as the "mature" or "emancipated" minor to determine the right to acquiescence for all medical care and many times use specific criteria to determine this (eg marriage, high sect graduation, pregnancy). (7)

In general, the right to confidentiality tread in the steps ofs from the right to approval to care for particular actions or services. Under circumstances in which physicians mark to maintaining confidentiality in the care of an adolescent, it is ethically and legally necessary to make this clear to the patient before services are provided. If an adolescent suits confidentiality and the physician is unwilling to provide it, this must be made clear to the patient immediately, and the physician should furnish a referral to an alternative provider. For example, health clinics storeed by Title X legislation are available from first to last the United States and are mandated to provide confidential sexual health services to minors. It is not acceptable to provide care and later disclose these services against the wishes of the patient. The barely exceptions to this are mandatory reporting of suspected child abuse or when minors are suspected to put out a danger to themselves or others.

The American Academy of Family Physicians, the American Academy of Pediatrics, and the American guild of Obstetricians and Gynecologists have issued policy recommendations that endorse providing confidential care to adolescents when not doing in like manner would lead to adverse health results (8-10) These recommendations encourage parental participation when appropriate, with the caveat that the participation should not stand in the way of be in want ofed care.

The policy recommendations emphasize that the best way to patronize the health of adolescent patients is to provide meaningful and timely anticipatory guidance to parents and children, with an observation toward improving family communication and supporting adolescents in their developmentally appropriate transition to independence. When that is not possible or desirable, however, we ne to be aggressive in protecting the confidentiality of our adolescent patients. Their health hangs on it.

REFERENCES

(1) Udry JR Bearman P for The National Longitudinal thought of Adolescent Health. Carolina Population Center University of North Carolina at Chapel Hill. Accessed online February 6 2004 at: http://www cpc.unc.edu/projects/addhealth.

(2) Harvey LK Shubat SC Physician opinion onward health care issues: 1987. Chicago, Ill: American Medical Association, 1987