By: Suanne Kowal-Connelly, MD, FAAP
Although pediatricians lend their own style to their examinations, many start the adolescent office visit with you and your child together. The doctor asks the typical questions. The variety of topics discussed may include the past year's medical history and any past and current problems; any medicines or complementary alternative medications that are used; allergies and eating, sleeping habits; how things are going with school, family, and relationships with friends.
This part of the visit is directed primarily to the parent, though the adolescent is always able to chime in as necessary. Before the physical examination, the doctor will ask the parent to allow some time alone with the adolescent.
Sometimes parents who know what is coming will ask several times, "Should I go now?" while we all chat together. It is fine to ask the doctor to let you know when it is a good time to step out so that you can feel comfortable with the process.
Why is one-on-one time important?
Parents and adolescents should understand the reasoning behind this routine. The pediatrician has built a relationship with you and your budding adolescent, sometimes over the entire course of your adolescent's lifetime, sometimes over a shorter period. No matter the amount of time, all patient-doctor relationships are built on mutual trust and respect.
The goals of the pediatric health care relationship include guiding and protecting the health and well-being of your adolescent. But it also includes preparing your adolescent for navigating an adult health care experience. In this way, we bridge this gap together and pave the way for your adolescent to confidently and independently join the adult health care world.
In many families, the biggest challenge for parents of adolescents is not how much more they can do for their kids, but how they can effectively do less. Parents should know that they can allow their adolescents to try, to fail, to learn, and to grow. We need to teach and prepare adolescents for the independence and responsibilities that lie ahead in both the health care arena and life in general. Parents and pediatricians can partner in this effort.
Still, it's a big step. Understandably, as a parent, you may have some questions. Here are some of the questions that parents generally ask when told that the doctor needs to spend some of the time alone with their adolescent.
"Is it that time already?"
The answer is…not really. The goal, however, is to begin to forge a more adultlike relationship with your child before adolescence is in full swing. With most families, the doctor-patient relationship has focused primarily on the parent and pediatrician. And certainly, through the early years, this was completely appropriate.
However, when you consider that one goal of parenthood is to prepare children to become adept and independent, teens need to begin to embrace and accept responsibility for their own health care. One reason for beginning this transition a little early is to foster that sense of responsibility and confidence in adolescents for taking charge of their own health. Many kids need a lot of time to do this.
Often when a doctor asks children direct questions with their parents in the room, such as what they ate for breakfast, when their last period was, and how they did in school this semester, they inevitably turn to their parent for answers! By starting the process a little early, kids might have a better chance of being more self-reliant and comfortable when they really need to answer tougher questions.
"I don't think my child will like that."
When parents say that they don't think that their child will be pleased about them having to leave the room, it is often a good sign that this is the very thing the child needs most. Children need to develop an ability to think independently, behave responsibly, relate to adults and carry on a conversation with an adult.
Pediatricians have been trained to recognize signs and symptoms of illness and disease, as well as signs of mental illness and dysfunction. They understand growth and development and the application of this to a child's and teen's health. They are advocates for children's and teens' well-being in every sense of the word. They are in a unique position to partner with your child concerning his or her health. This is the time in children's development that forming a separate bond with their doctor can be of benefit to them. With your support, your child can be gently pushed to move in that direction.
"Aren't they too young?"
Whether a child or teen is too young for an independent chat with the doctor depends on what happens in the visit. If the doctor is examining a 12-year-old girl who has not yet begun menstruating, they will not be discussing whether the girl is sexually active and how she is ensuring her sexual health safety. But this age is not too young to begin to practice behaving as a young adult, to begin to learn how to express feelings and how to think independently about health decisions such as choosing healthy foods. This is a great time for pediatricians to engage with their patients and become trusted health care advocates for them. As your children mature, the scope of topics discussed in a well visit change to appropriately conform to their developmental stage.
"Why exactly do you need to do this?"
The question of why doctors need to meet with adolescent patients alone likely stems from fear on the parent's part. The teen years are the gateway to adulthood, and with that comes teens' desires to test their new wings. Adolescents are naturally more open about certain topics when parents are not listening simply because they might not want to disappoint or alarm their parents even if all they have are questions. Sometimes, an adolescent might have a very stressful and serious situation in his or her life that needs to be addressed and requires privacy and confidentiality. This guaranteed alone time with the pediatrician will allow and reassure the adolescent that there will always be an opportunity to discuss very pressing matters.
"Will you be sharing this private and important information with me?"
The short answer is no. Although the actual law governing a minor's rights to confidentiality can be vague and vary from state to state, pediatricians respect a child's right to privacy and will protect it, except in the circumstance in which an adolescent discloses that he or she is being hurt or is looking to hurt himself, herself, or others. Legislation has expanded the rights of minors to make health care decisions for themselves.
These laws were enacted to assist in situations in which notifying a parent would pose an obstacle to an adolescent's receiving necessary medical care. Sadly, not all families have healthy, open, and well-functioning channels of communication, and for those families, there needs to be a method of ensuring that, when necessary, a child's right to privacy will take precedence over a parent's right to know. Some examples of these circumstances include the following:
However, a minor does not have unrestricted access to health care. The mature minor doctrine gives physicians some general guidelines for when they may provide medical treatment based on an adolescent's consent. (States vary on whether this is adopted as doctrine, but courts recognize the principle.)
The bottom line is that if an adolescent is in trouble, pediatricians will do the following:
Assess the medical and emotional needs of the adolescent.
Make recommendations on how to include the parent, including an offer to be the health communication liaison between a parent and an adolescent.
Respect the wishes of the adolescent if the pediatrician feels there is cause to believe that the adolescent's rights to health care supersede the parent's right to know and the adolescent has sufficient maturity to support that decision.
Remember
You have worked tirelessly as a parent to raise a child who respects your values. Pediatricians know that because, in many instances as parents ourselves, we have done the same. In the end, though, children make independent decisions about which of their family's values they will choose for themselves. Your adolescent's physician will encourage them to share important physical and emotional health issues with you; however, there will be times that an adolescent will want something to remain private. Pediatricians are partners in your child's health care, and you can count on them to assist with their health care concerns.
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About Dr. Kowal-Connelly
 Dr. Kowal-Connelly is an avid triathlete and a USAT (USA Triathlon) Level I Certified Coach and a USAT Youth & Jr. Coach. She has founded
www.HealthPoweredByYou.com, a place where families and organizations can learn strategies for successful lifelong health and wellness. She is a frequent contributor to HealthyChildren.org. She is also the very proud mother of three grown sons. Follow her on Twitter
@healthpby and
@suannekowal.
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