Adolescent Health Care, Confidentiality

Concerns about confidentiality may create barriers to open communication between patient and physician and may thus discourage adolescents from seeking necessary medical care and counseling.

When caring for an adolescent patient:

• The AAFP believes that adolescents’ access to confidential healthcare is important for their health and well-being, while also recognizing the benefit of supportive parental involvement.
• Family physicians should be aware of their community's standards regarding adolescent confidentiality. State laws vary, but in general, in areas of care where the adolescent has the legal right to give consent to health services, confidentiality must be maintained.
• The adolescent should be offered an opportunity for examination and counseling separate from parents/guardians, and the physician should encourage and assist the adolescent to involve parents or guardians in healthcare decisions.
• Physicians should deliver confidential health services in situations involving reproductive health, sexuality, gender identity and expression, substance use, and mental health to consenting adolescents.
• If communication between the adolescent and parent cannot be facilitated, every effort should be made by physicians and their staff to ensure confidentiality within the limits of legal and ethical standards.
• Adolescent patients should be made aware that certain situations and circumstances create limitations on guaranteed confidentiality.  For example, detailing billing statements and Explanation of Benefits notices may be furnished to a guarantor/parent from a third party.  Further, information suggesting someone is in imminent danger, the suspicion or evidence of abuse, and the diagnosis of certain communicable diseases all must be reported to the proper authorities.
• Family physicians using electronic medical records should consult their vendor to be certain patient portals are properly configured to meet state standards regarding confidentiality for adolescents whose parents and guardians have proxy access to their records.

Ultimately, regarding confidentiality, the judgment by the physician regarding the best medical interest and safety of the patient should prevail.  (1988) (2020 COD)