Jan 272019
 January 27, 2019  Posted by  Healthcare, Youth & Schools

Joe Cadillic sent along an article that’s a good reminder to parents to make sure that they understand their state’s laws and the policies of any doctors or hospitals they may take their children to — or that their children may contact.

KCRG reports:

A Coralville father recently found out he will no longer have access to his 12-year-old daughter’s medical records so he asked KCRG-TV9’s I9 investigative team to investigate.

Kevin Christians, of Coralville, says a letter triggered his concerns alerting him he was losing access to his daughter’s medical records.

At University of Iowa Hospitals and Clinics, parents are no longer able to see test results, messages from doctors and other information once a child turns 12.

The letter says the hospital wants kids at that age to be more active in their own health care. Christians believes 12 is too young to keep parents in the dark.

Read more on KCRG.

In my own practice, I informed parents of minor children the age at which our state grants children privacy and confidentiality in their medical care. But I also told parents my policy for my practice, which granted children privacy and confidentiality even earlier than what the state granted— with certain exceptions that I made clear to both the parents and the children.

There are good reasons to grant children medical confidentiality. But there are also important reasons that parents understandably want to know what is going on with their child.  In my clinical experience,  most young children and adolescents were willing to share information with their parents if I talked with them about why it was important to bring their parents in on something and if I told them that I would be present and help them talk to their parents about an issue. In only a very few cases did a child ever outright refuse and stick to the refusal.

On balance, I think that granting privacy and confidentiality was overall a good thing that engaged the children more in their own care.  More importantly, even, it made them feel safer to reveal disturbing thoughts, feelings, or compulsions, knowing that they would be able to discuss them and seek help for them without their parents finding out about some symptoms or issues until they felt better ready to disclose to their parents.

I  think the bigger concern many parents may (understandably have) is if their child is seeking intervention for an unwanted pregnancy, a sexually transmitted disease, severe and life-threatening psychiatric disturbance, or some form of substance abuse.  Suicides in the under-15 age group have been increasing, and it’s a real concern.

So how do we balance these concerns that may seem to be in conflict? Blanket guarantees of confidentiality and privilege may not be the smartest approach and laws and policies may well want to include the kinds of exceptions I wrote into my policies — that I could not keep a child’s “secret” if the secret involved them planning to harm themselves, or others.  Nor could I keep a child’s secret if they revealed that someone was harming them  (i.e., exceptions for the kinds of issues that mandated reporters must report).

But where would that leave us with a teenager who discovered that she’s pregnant and wants to arrange for an abortion?

Under my state’s laws, if the teen is 14 or older, she has confidentiality and privilege.  And I think that’s how it needs to remain — particularly if you can’t be sure whether the pregnancy might be due to incest by a family member or if a family member might become abusive or violent if they learned of the pregnancy or intended abortion.  But what about an 11-year old?  Don’t the same risks apply to her?  Shouldn’t we also be concerned about danger to her if we do not protect her confidentiality?

As healthcare professionals, we have not just a duty to “warn,” but a duty to protect, and that includes a duty to protect our patients – even from themselves in some situations.  But does our duty include a duty to protect children or adolescents from judgements that we think are not in their best interest?  No, not if the alternative is violating confidentiality and privilege.

I just wish states and entities would think a lot more about at what age we should be granting confidentiality and privilege — and whether we might need a tiered approach depending on the nature of the decision-making or the potential seriousness of the consequences.  But even then, I can see some arguing that either children are either old enough to engage in self-determination or they are not.

This is not an easy situation.  If a 12-year old came to you and said,”I’ve given this a lot of thought and I believe I am perfectly capable of driving safely, so I am going to start driving a car, even though I have no license and my parents know nothing about this,” well……  what next?


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