Caring For Kids And Their Parents

Teen Confidentiality

Scenario Analysis

The most challenging aspect of adolescent care is getting the patient to understand and believe that when you say the discussion will remain confidential, you really mean it. Also of great importance is learning how to talk to young people and how to get them to talk to you. As a physician, you need to learn how to deal with adolescents effectively so that they feel comfortable talking to you and are willing to accept your advice.

In Scene 1, Carla, an adolescent, comes in with her mother for a physical exam and attempts to have a private discussion with the physician, apparently about adolescent issues. Her mother becomes furious at the idea. The doctor attempts to have the mother leave the room, but when she refuses he does not press the issue. As a result, Carla has some difficulties discussing these sensitive issues. She also is not comfortable with the doctor due to his approach when addressing difficult issues. This scenario reflects failure in establishing a relationship with the adolescent.

Scene 2 depicts how easy it is for a physician to establish an excellent rapport with both the adolescent and the parent. Right after introducing himself and identifying the reason for the visit, the doctor talks with Carla and her mother about the need for adolescent patients to have time alone to talk with their doctor in private. The mother is resistant at first, but the physician’s careful explanation of why this is necessary ultimately convinces her.

Scene 3 demonstrates a physician developing an excellent rapport with the adolescent patient during their one-on-one meeting. The physician emphasizes the confidential nature of the conversation they are about to have in order to ensure that Carla is comfortable and feels the environment is safe. When she begins to raise questions that are obviously still uncomfortable for her, he responds in a nonjudgmental way. By pulling over a chair and sitting down, he conveys the nonverbal message that he is prepared to spend as much time as necessary for questions and answers. When she raises a fairly specific question about sexually transmitted diseases, he indicates that he will answer that question but that it may first be appropriate to put her overall sexual history into context. By using open-ended questions he creates a safe environment in which she can communicate in a manner that is comfortable for her.

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