Part 1 of ebook Adolescent gynecology: A clinical casebook provide readers with content about: general and developmental approach to adolescents; menstrual disorders; sexually active adolescents; case of a girl with a secret; case of a girl due for human papillomavirus immunization;... Please refer to the ebook for details!
Menstrual Disorders 6 Case of a Girl with Irregular Periods, Acne, and Hirsutism
General and Developmental Approach to Adolescents
H.J Talib (ed.), Adolescent Gynecology, https://doi.org/10.1007/978-3-319-66978-6_1
Case of a Girl with a Secret
Nadia L Scott and Elizabeth M Alderman
Confidentiality is a crucial component of the therapeutic relationship between adolescents and healthcare providers, particularly concerning sexual, reproductive, and mental health Research indicates that adolescents may avoid seeking necessary care for sensitive issues if they fear their information will be shared with parents To protect adolescent privacy, laws have been enacted at the state level to secure confidentiality for services such as STI testing, contraception, and mental health counseling, though these laws can vary and depend on the minor’s capacity to make informed decisions Exceptions to confidentiality exist, especially when adolescent safety is at risk Challenges like billing processes, electronic medical records, and patient portals can also threaten privacy Therefore, healthcare providers should stay informed about local confidentiality laws and proactively discuss confidentiality with adolescent patients during every encounter to foster trust and ensure access to essential care.
E.H is a healthy 15-year-old girl undergoing her annual physical before starting high school, with no significant medical history and recent well health status She has been under your care since infancy, and her mother accompanies her to the appointment During the visit, her vital signs are recorded, and both are informed about her stable health and academic progress, including her plans to enroll in Advanced Placement courses.
Division of Adolescent Medicine, Department of Pediatrics,
The Children’s Hospital at Montefiore, Bronx, NY, USA e-mail: nascott@montefiore.org; scott.nadia@gmail.com
Pediatric Residency Program, The Children’s Hospital at Montefiore,
The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY, USA
During the physical exam of E.H., her mother was asked to wait in the designated waiting area I explained to both E.H and her mother that, in addition to the physical assessment, I would be asking E.H a series of additional questions relevant to her health I reassured them that any information E.H shared during this confidential interview would remain between us, except if it involved disclosures indicating harm to herself or others or potential danger, which I am ethically obligated to address This confidential interview is a standard component of healthcare maintenance visits for adolescent patients, helping to ensure comprehensive and sensitive care.
After E.H.’s mother leaves the room, she discloses that she and her boyfriend of one year have recently become sexually active and are interested in contraception options She has not informed her mother about her sexual activity and requests confidentiality, expressing concern about her parents discovering her use of contraception through bills for her healthcare services E.H mentions hearing about the oral contraceptive pill from classmates and is considering trying it to manage her reproductive health discreetly.
1 How should providers begin a discussion on confidentiality with patients and parents?
2 How should providers balance the rights of adolescents’ privacy regarding certain elements of their health with parents’ responsibility to be a part of their adoles- cent child’s health?
3 What limitations exist to the confidential relationship between health-care provider and adolescent patient?
4 How are confidential health-care services that are provided to adolescent patients paid for without informing their parents whose insurance is billed?
5 In an era of electronic medical records and electronic patient portals, what new challenges have arisen to ensuring confidential health-care services for adolescents?
Adolescents occupy a unique stage of development physically, socially, and psychologically As they mature into adults, they undergo physical growth and emotional separation from their parents During this period, they start to develop their own behaviors, opinions, and values, shaping their individual identities.
Adolescent medicine uniquely addresses private aspects of health, including romantic and sexual relationships, reproductive choices, and mental and emotional well-being This specialized field focuses on supporting teenagers through their complex developmental and emotional challenges By emphasizing confidentiality and personalized care, adolescent medicine helps young people navigate their health and human experiences during this critical stage of life.
Adolescents value their privacy and may withhold vital health information to prevent parental discovery, sometimes avoiding necessary care to protect confidentiality To effectively care for adolescent patients, healthcare providers must prioritize issues of privacy, confidentiality, and consent, recognizing these as essential to fostering a trusting therapeutic relationship Confidential care is particularly crucial for services such as STI screening, mental health support, contraception, and pregnancy, with specific provisions varying by state law Addressing these unique adolescent health needs through dedicated confidentiality measures ensures better health outcomes and encourages adolescents to seek timely medical assistance.
The protection of confidentiality and the importance of informed consent are vital in adolescent healthcare While minors under 18 are generally unable to assess medical diagnoses and treatment risks independently, parents or legal guardians usually hold the responsibility to provide medical consent on their behalf Conversely, individuals aged 18 and older are legally considered capable of giving informed consent if they possess the mental capacity to understand the potential risks and benefits of medical interventions Ensuring that adolescents’ confidentiality is maintained during medical care is essential to promote trust and respect their autonomy within the boundaries of legal and ethical standards.
Adolescents face more complex consent guidelines, as each state has specific laws governing minors' ability to consent to various health services These services include treatment for sexually transmitted infections, contraception, pregnancy-related care, mental health, substance abuse, and sexual assault support Importantly, adolescents often have the right to access these services confidentially without parental notification, unless they explicitly consent to share their diagnoses and interventions with their parents.
Parents or guardians retain the right to access test results and medical diagnoses for minors outside protected areas, ensuring they are informed about their child's health They also have the authority to grant or withhold consent for medical tests and procedures outside the confidential zones, maintaining their role in healthcare decision-making for their child.
1 Case of a Girl with a Secret
Emancipated minors—those who are married, parents, enrolled in the armed forces, or financially independent—are entitled to consent to all of their own healthcare Minors who are parents may also have the legal right to consent to healthcare for their children, depending on state laws Additionally, pregnant minors possess expanded rights, including the right to confidentiality for all prenatal healthcare services and related medical issues that could impact their pregnancy.
A mature minor may also have extended consent and confidentiality protections
A mature minor is a person under 18 who demonstrates sufficient intellectual and psychosocial development to understand medical decisions and their consequences, though the specific definition varies by state and healthcare provider judgment Key factors in identifying a mature minor include age, education, intelligence, life experience, and prior involvement in healthcare choices Generally, if a medical service is low-risk and follows established protocols, a mature minor may legally consent without parental approval The application of the mature minor doctrine is case-specific and its scope differs across states, requiring careful individual assessment from healthcare providers.
Policy and Legislation Supporting Adolescent Confidential Care
Since the 1980s, confidentiality in adolescent healthcare has been supported by health policies and legislation, emphasizing its critical role in promoting adolescent well-being Major professional organizations such as the American Academy of Pediatrics (AAP), the Society for Adolescent Health and Medicine (SAHM), the American Medical Association (AMA), and the American College of Obstetrics and Gynecology (ACOG) have issued policy statements highlighting the importance of maintaining confidentiality between adolescents and healthcare providers These policies specifically stress the necessity of confidentiality in sensitive areas like sexual and mental health, ensuring adolescents feel empowered to seek care and discuss personal issues openly.
Federal and state laws aim to ensure confidential healthcare for adolescent patients, building upon common law privacy protections These protections guarantee confidentiality in reproductive health and family planning services, as established in landmark cases like Griswold v Connecticut.
Title X, passed in 1970 as a part of the Public Health Service Act, provides fed- eral financial support for the provision of affordable family planning and sexual
In 1978, Title X was expanded to require clinics to provide confidential sexual and reproductive health services to adolescents With approximately 20% of the 4.5 million patients served annually in Title X clinics being under 19, these protections significantly impact a large number of adolescents seeking care.