In my many years as a pediatrician, I have seen thousands of children through the transition from childhood to adulthood. While the teenage years can be trying and chaotic, they also hold great opportunity for growth and new understanding.
But whether I've known families since the children were born or only for a few years, I still sometimes struggle with how to present the subject of teen confidentiality in the very positive light in which I view it.
State laws, federal funding regulations and case law including Supreme Court decisions all govern doctors' legal requirements for treating minors. There may be differences in these various dictates, but the overarching principles are the same.
Teens need to be able to confer with their health care providers, to confide in them without fear of reprisal and to seek medical care for various conditions and behaviors.
Our goals with teenagers are to promote health and prepare children for adulthood. Learning to communicate effectively with their doctor is part of the process. Most importantly, teenagers deserve the same privacy, respect and individual attention a doctor gives to any patient.
But it's more than that. It's complicated. My relationships with teens and their families go far beyond who can say what to whom. Parents have always been an integral part of the doctor-patient relationship I have with children.
Often I've known the parent longer than the teen, either by way of a prenatal interview or through the teen's older siblings. In some cases, the parents and I have been through this before. In other situations this is brand-new territory.
When their children were little, I relied on parents for most of the history, letting them tell me what's going on with their kids.
During the early school-age years, I talk mostly to the kids themselves, letting parents add or correct as needed along the way.
But with teenagers, things change. There may be things they want to discuss with me that they're not quite ready to share with their parents. And that's where things get tricky.
That's where I have to ask parents to trust me. I try to assure families that we all have the same goal: to keep their kids safe and healthy in a sometimes scary world.
I usually start the interview with everyone in the same room. Sometimes parents have called me on the phone beforehand to voice concerns about their child or to ask me to bring up certain topics (invariably already on my agenda, too.)
I ask about sex and drugs and alcohol, often to the wide-eyed incredulity of the teen. But I do it for a reason. I want to show parents that it's OK to talk about these things with their kids.
And I want the kids to know their parents aren't going to drop dead at the mention of the unmentionable. I talk about confidentiality: which things I have to disclose (like if I feel the teen is a danger to himself or others) and which ones I don't (like a request for contraceptives or testing for sexually transmitted infection.)
Then I suggest that perhaps the teen would like to talk to me alone. (Despite the somewhat tongue-in-cheek title of this column, I never throw parents out of the room against their or their child's will.)
I repeat the same questions I asked in front of the parent, not because I assume they've lied the first time around, but to give them the space and time to bring up their own issues, ask questions they may be too embarrassed to ask anyone else and get answers they need to make healthy informed decisions about their lives.
Our conversations aren't limited to sex and drugs. We discuss education and exercise, relationships with teachers and peers; basically anything they want.
Despite my obligation to maintain a confidential relationship with my teenage patients, I always encourage them to confide in their parents. I offer to do that with them if they like.
"Oh, they'll kill me," is often the response I hear from a newly sexually active teen. I understand they may know their parents best.
But I like to think I share a perspective with their parents that they don't. After all, I'm a parent, too. I try to offer the alternative possibility that although their parents may have some initial reservation or even dismay, they usually adjust quickly to the new reality and can provide much needed emotional support to the teen in transition.
In fact, parents are often in the long run pleased that their son or daughter is taking steps to keep themselves healthy and safe.
The transition from teenage years to adulthood is a scary and wondrous time in a parent's life.
Remember the first time your child, maybe at the age of 2 or 3, came out with a word you know didn't come from you? It's a sobering moment, one that places the child squarely in the context of a larger community.
We have to get used to the fact that we parents are not the sole influence in our children's lives any more. In the teen years, there's that same sense of wonder and trepidation.
It all comes down to trust. When I go into that room alone with their child, I am asking parents to trust me. To trust that I have their children's best interest at heart. To trust that I will give their child the same good guidance and advice that they would.
My basic philosophy for raising children (and being a pediatrician for that matter) is this: the more caring adults we can surround our children with, the better. The more caring adults, the more good role models. The more caring adults, the more resources they have to rely upon in times of need.
Those caring adults may be teachers, guidance counselors or friends of the family. The point is, as a pediatrician, I would like to count myself among the caring adults in the lives of my patients.
Dr. Carolyn Roy-Bornstein is a board-certified pediatrician with Merrimack Valley Child and Adolescent Health and Merrimack Valley Hospital. Her office is at Merrimack Health Center, 62 Brown St., adjacent to the hospital. She can be reached at 978-521-8108. Parents are invited to e-mail questions that might be addressed in a future column to CRoy.MVCAH@comcast.net.