The Family Physician’s Role in Adolescent Health Care: Sexuality and Maintaining Confidentiality

By Riley Stanton, CAFP Communications and Marketing Intern

Family physicians have the unique opportunity to see their patients grow from infancy to adulthood. During that transition, there is a tricky period in adolescence when these patients who once relied entirely on their parents begin to make their own decisions, and that includes decisions about their health. Patients as young as 11 deserve one-on-one time with their healthcare providers, strengthening the patient-provider relationship and allowing the young patient to speak openly about mental and physical health concerns. Unfortunately, of teens aged 15-17, only 38% had one-on-one time with their physician in the past year. This time is important for adolescents to develop autonomy and take responsibility for their own health, as well as to learn how to have honest conversations with an authority figure1.

Adolescents may be exploring sexual orientation, their gender identity, experimenting with sexual behaviors or substances, all of which influence their health.  The AAFP believes it is important for an adolescents’ health and well-being to have access to confidential healthcare while also appreciating the benefit of supportive parental involvement1. However, in some situations, what the parents want and what the adolescent needs are not the same. You may encounter this conflict in decisions about your adolescent patient’s mental health, sexuality, or even vaccination status.

Concerns about confidentiality can create barriers to open communication between a young patient and their physician, discouraging an adolescent from pursuing care or counseling they desperately need1. One-third of middle and high school students report they did not seek health care because they did not want their parents to find out2. Staying true to the AAFP’s stance that supportive parental involvement is beneficial to all, every effort should be made to facilitate open communication between the adolescent and their legal guardian. However, when this is not possible, the adolescent should be offered examination and counseling separate from parents or guardians1.

First and foremost, adolescent patients should be made aware that limitations exist on guaranteed confidentiality1, 2. If the information they provide you leads you to believe anyone is in imminent danger, evidence of abuse or a diagnosis of communicable diseases (such as STIs) must be reported to the proper authorities2. Also, when using their family insurance plan, an Explanation of Benefits or detailed billing statements can reveal the reason for their visit through diagnostic or procedural codes1. Additionally, if your office uses electronic medical records with patient portals, you should be aware of the configuration of those records1. If a parent/guardian has proxy access, are they able to read detailed visit notes and diagnostics? Do your portals meet the state standards for confidentiality for your adolescent patients?2

Unfortunately, in some instances, revealing personal medical information of a minor to their parent/guardian could place the young patient at risk of violence or neglect. When this is the case, special privacy provisions of HIPPA allow you, as the health care provider, to use professional judgment that disclosing such information would place the minor patient at substantial risk and deny the parent/guardian access to the health information2.

Privacy concerns regarding gender identity, sexuality, screening and treatment of STD/STI, and contraceptive or family planning services are the greatest concerns for this age group. In a survey conducted in Wisconsin of sexually active adolescent females seeking these services, over half said they would not use the clinics if parental notification were necessary. Furthermore, of those who said they would stop going to a clinic for prescription contraceptives or STD services, only 1% would stop having intercourse. They would use less-effective methods of protection or none at all, putting themselves and their partners at higher risk of unintended pregnancy and disease2. In Colorado, minor patients can consent to contraceptive and STI services without parental notification or consent; however, abortion services do require parental notification except in cases of abuse, assault, incest or neglect3.

Sexuality and reproductive or family planning services are not the only health services during which adolescent patients may seek confidentiality. Young patients may want to discuss peer pressure, bullying, substance use, body image, mental health, and more. As a family physician, you can open the doors to these conversations by asking open-ended questions during one-on-one appointments and inform your young patients of their rights to confidentiality concerning these issues.

  1. AAFP. Adolescent Health Care, Confidentiality. 2018; Available from: https://www.aafp.org/about/policies/all/adolescent-confidentiality.html.
  2. English, et al., The Hippa Privacy Rule and Adolsecents: Legal Questions and Clinical Challenges. Perspectives on Sexual and Reproductive Health, 2004. 36(2).
  3. Institue. Parental Involvement in Minors’ Abortions. 2019 10.01.19 [cited 2019 10.14.19]; Available from: https://www.guttmacher.org/state-policy/explore/parental-involvement-minors-abortions.

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