The health needs of adolescents differ from those of younger children. The adolescent struggles with independence. With greater independence, adolescents have more opportunities to engage in behaviors that place them at risk for health problems, including drug use and sexual activity. A behavioral assessment is essential in caring for adolescent patients. Addressing adolescent behaviors is often difficult for the medical provider. Among the reasons for difficulties arethepracticallimitationsof effectivelycommunicatingwith the adolescent and also concerns regarding the legal and ethical dimensions for providing care for this age group. Providers of medical services to the adolescent patient must create a welcoming environment for the patient so that she or he feels comfortable discussing problems. A nonjudgmental approach will encourage adolescents to disclose information about their behavior. Although the goal of the provider may be to perform an assessment of the adolescent's risk-taking behaviors, this is best done after establishing a rapport and the patient feels like the provider cares about him or her as an individual.
Providersshouldroutinelyinterview their adolescentpatients both with their parents in the room and also after asking the parent to leave the room so that the patient has every opportunity to discuss sensitive issues. Talking individually with adolescents is important because many adolescents want to talk about sensitive health information but fail to do so because of the lack of opportunities for private discussion.
Many pediatricians find it awkward to ask parents to leave the room during part of the interview, but most families respect the adolescent's need for privacy. Adolescents and their parent(s) should be informed of the right of adolescents to confidentiality and to consent for their own medical care. By communicating clear guidelines,there will be less room forconfusion and increased chances that adolescents will seek the advice of medical personnel regarding sensitive issue in the future.
State and federal laws have been developed to provide protection to adolescents who are concerned about health problems but do not want to disclose the information to their parents and who may forgo medical care as a result. It is important for practitioners to be familiar with the laws of consent and confidentiality in their own state, because variability between states exists.
Informed Consent: Parental consent generally is required for the medical treatment of minors. However, there are situations in which an adolescent can give informed consent without the consent of a parent. These situations include emergency care, care for emancipated minors, and state-mandated situations.
• Emergency care: Patients who present to the emergency room for
medical services are required under the federally defined Emergency
MedicalTreatment and Active Labor Act (EMTALA) to receive an appropriate medical screening and necessary testing. EMTALA preempts
conflicting or inconsistent state laws, essentiallyrendering the problem of
obtaining consent for the emergencytreatment of minors a nonissue.
• Emancipated minors: The definition of emancipated minor differs by
state. For example, some states define the emancipated minor as someone
who is older than 16 years, lives apart from his or her parents, and is
economically independent.
• State-mandated situations: These might include abortion services,
treatment for sexually transmitted infections, prenatal care and delivery
services, treatment for drug abuse, and outpatient mental health care.
Confidentiality: Parents generally have the right to medical information and records of their children. However, many states have given adolescents the right to confidentiality in specific situations, including state-mandated situations, as discussed above. Exceptions to confidentiality include reporting of sexual abuse, alerting authorities in the case of homicidal intentions, and taking appropriate measures to protect a suicidal patient.
By effectively communicating with adolescents, including discussions with adolescents without a parent present, and equipping them with knowledgeregardingtherightsofadolescentsinconsentandconfidentiality,health care professionals will be in a position to maximize the health status of their adolescent patients.
Bitterman RA. The medical screening examination requirement. In: Bitterman RA, ed.
EMTALA: Providing Emergency Care Under Federal Law. Dallas, TX: American College of
Emergency Physicians, 2000:23–65.
Cheng TL, Savageau JA, Sattler AL, et al. Confidentiality in health care. A survey
of knowledge, perceptions, and attitudes among high school students. JAMA. 1993;
269(11);1404–1407.
Committee on Pediatric Emergency Medicine of the AAP. Consent for emergency medical
services for children and adolescents. Pediatrics. 2003;111(3):703–706.
Ford CA, Millstein SG, Halpern-Felsher BL, et al. Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A
randomized control trail. JAMA. 1997;278:1029–1034.
King NM, Cross AW. Children as decision-makers: guidelines for pediatricians. J Pediatr.
1989;115:10–16.
Resnick M, Blum RW, Hedin D. The appropriateness of health services for adolescents: youth's
opinions and attitudes. J Adolesc Health Care. 1980;1(2):137–141.
Review other book chapters online related to Juvenile myoclonic epilepsy:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7489-6 
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