One reason that adolescents forgo medical care is that they may be concerned about confidentiality. Their parent(s) may have always gone to the doctor with them and they are concerned that he or she will tell the parent about any behavior they report to the doctor. This is why at about age 12 (in California) some doctors will tell youth that anything said to them is confidential and start asking the parent to step out of the room for a minute during a physical or ask the child if they would rather meet with the doctor alone.
As health care professionals, we want the adolescents to trust us and disclose any risk behavior so that referrals or appropriate care can be provided. To encourage this, there are confidentiality laws in most states, although I dare say most parents and even some doctors are not clear what they mean.
I will summarize the laws (for minors) related to reproductive health care in California. A minor of any age may consent for care for pregnancy, contraception, abortion, emergency medical services, or sexual assault and rape services. The health care provider may not inform the parent if a minor seeks care for pregnancy, contraception, or abortion. The health care provider must contact the parent for emergency medical services and sexual assault (unless the parent is responsible for the assault, or the minor is over 12 and treated for rape).
A minor over the age of 12 can request testing or treatment for sexually transmitted disease, including HIV, as well as rape, and the health care provider may not tell the parent without the minor’s (signed) consent. That means that parents cannot see the medical records relating to reproductive services of teens.
Reporting the sexual activity of minors to children’s protective service or police If a minor is being coerced or exploited into sexual activity, it is reportable. In addition, if a minor is having consensual sexual intercourse with an older partner, it is reportable if the child is 11 – 13 and the partner is 14 or older; and if the teen is 14 – 15 and the partner is 21 years or older.
A note to doctors: Even though the laws are in place to encourage teens to seek and receive care, the “system” may provide leaks and physicians must protect teens by understanding how billing and Explanation of Benefits, satisfaction surveys, appointment reminders and lab results are handled. If there is a chance that a parent will find out the teen was seen for a confidential reproductive service, it would be better to refer them to a local Planned Parenthood, or work with your institution to eliminate the barriers to providing care.
A note to parents: I know that the fact that your teen can receive health care for pregnancy, contraception, abortion, testing or treatment for sexually transmitted disease, including HIV, as well as rape without your knowledge or consent may surprise, and maybe outrage you, but please take a deep breath and think about this: if your child is involved in sexual behavior, and you do not know, wouldn’t it better for the doctor to know, provide information and protection to avoid unwanted pregnancy and sexually transmitted infection? The way to avoid this situation is to be an approachable parent. Start early and talk to your kids about everything - sex, alcohol, smoking, drugs, rape, and every other difficult subject –include your values and expectations - you will be glad you did, and it will increase the chances that you will know when your teens become sexually active.