What’s It Mean When the Doctor Wants To Speak Privately With Your Teen?

Since your kids were tiny, you’ve been in the doctor's exam room with them for everything: Basic well-health appointments to higher-stakes visits such as broken bones or specialized testing for serious medical concerns. Whatever it was, you were fully informed and had some say in the process.

Until today — when the doctor asked to talk to your teen without you or another caregiver in the room.

It can feel alarming when the doctor doesn’t want you in the room with your child. What could they be doing or saying that you can't be present for? But Cynthia J. Mollen, MD, MSCE, an attending physician and Division Chief of Emergency Medicine at CHOP, identified several important reasons healthcare professionals may ask to talk to your teen without you being present.

Privacy

Everything your teen discusses privately with a healthcare professional remains confidential – with one key exception: physical harm. If they say they want to hurt themselves, hurt someone else, or if they disclose that someone is hurting them, the healthcare provider may be mandated to report that interaction.

During confidential conversations with teens, doctors will ask a range of questions including:

• How are you doing in school?
• What activities do you like?
• Do you have suicidal thoughts?
• Do you feel safe at home, in school, in romantic relationships and/or with your friends?

Clinicians may also ask your teen about their:

• Eating behaviors
• Sexual activity
• Drug and alcohol use

It's important to understand doctors ask these questions of every teen patient — no matter the reason for their visit. It doesn’t necessarily mean the doctor has seen something worrisome. It’s simply good practice to discuss these topics at each visit. It normalizes the process and gives health professionals a better chance of addressing any problems while they’re still smaller and more manageable.

Opportunity

As children go into their teen and young adult years, they’re much less likely to see a healthcare provider regularly. A surprising number of teens only encounter the healthcare system during an emergency department (ED) visit. So, this might be the only opportunity healthcare providers have to address critical health issues like depression, anxiety, physical or mental abuse, safe sexual activity, or other risky behaviors.

Medical organizations, such as the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) recommend that health providers who care for teens provide private, confidential care.

The good news for parents is this: Most teens are healthy and aren’t sexually active, aren’t using illegal substances, and don’t have a mental health condition. But those teens who are at the greatest risk of harm — whether from binge drinking, unsafe sex or suicidal thoughts — are more likely to discuss these issues with a healthcare provider when they feel confident their discussions are private.

“It can be easier for teens to discuss sensitive topics with their healthcare provider rather than their parent, given the different nature of the relationship,” said Dr. Mollen. “They may view the healthcare provider as an objective listener/partner.”

She noted it’s helpful if the doctor makes a point of framing the conversation as routine to both the teen and parent. Doctors should cover a few key points before asking any questions:

• They ask all teen patients the same type of questions
• The discussion is part of helping teens learn how to manage their own healthcare
• Knowing more about the individual teen and their daily life helps the doctor keep them healthy
• What confidentiality does and does NOT cover

Framing the conversation this way can ease any worries the teen has, ensures they understand their rights so they can be forthcoming with their responses, and reassures parents that their child is not being singled out for questioning.

Self-advocacy

It’s recommended that all health providers talk with teens privately, but too often, teens aren’t given that opportunity, particularly during ED visits.

Parents, caregivers and teen patients should expect a chance to have a private discussion with a healthcare provider and advocate for the opportunity if it’s not offered. It doesn’t matter if you think your teen has a stomach bug, the flu or a sexually transmitted infection. Giving them the autonomy to discuss their symptoms, care and concerns today will help them talk confidently to their healthcare providers for years to come.

Dr. Mollen said teens are usually very open to having these conversations with their healthcare providers. Parents and caregivers can help normalize the process by easily agreeing to step out of the room.

To keep the conversation as productive as possible and head off any nerves, caregivers and healthcare providers should make sure teens understand:

1. Why it's important to have confidential medical discussions
2. How they can feel empowered to take control of their healthcare needs
3. What their individual rights as patients are, such as:

• Dignity and respect
• Information sharing
• Participation
• Collaboration

Start the conversation

No matter how close a parent and teen are, it’s not always easy to start a conversation on a serious issue — especially when it’s about a sensitive topic, such as their sexual activity, sexual orientation or drug/alcohol use. But, Dr. Mollen says, the touchier the subject, the more important the conversation is.

For help getting the ball rolling, parents and other caregivers can find helpful resources through the Center for Parent and Teen Communication, founded by Children’s Hospital of Philadelphia’s Kenneth R. Ginsburg, MD, MSEd.