Confidentiality and consent in the care of the adolescent patient

Confidentiality protections are critical in the provision of comprehensive primary care of adolescent patients. The protections differ based on state laws and are limited by electronic health record documentation and billing operations of individual physician practices. Physicians need to strive to increase their knowledge regarding confidentiality protections for their adolescent patients. Moreover, physicians should understand their role in preventing possible confidentiality breaches. For the 16-year-old girl who is requesting sexually transmitted disease (STD) testing: Based on evidence quality D, all states allow for confidential STD testing, but there are some states that may require the physician to disclose to parents any positive results, and you will need to reflect on the laws guiding practices in your state. Based on evidence quality D she should be notified about the possibility of an explanation of benefits letter being sent to her home because of office billing and laboratory testing, thus possibly disclosing some sensitive information, and she should be notified of the alternative ways available for her to pay for these services, including information on how to obtain a subsidized health insurance plan if available in your state to maintain confidentiality. Based on evidence quality D, if your state does not offer subsidized health insurance plans you may need to refer her to Planned Parenthood or a public health clinic. Alternatively you can counsel her on having her partner share some of the cost of her laboratory testing and subsidize the fee for her office visit. Based on evidence quality D, ensure that your office electronic health record has protections for adolescents and that no sensitive diagnoses, tests, or medications are printed on the after-visit summaries that could be easily seen by her parents. Moreover ensure that you have designed your patient portal to disable release of laboratory results of adolescents younger than 18 years. Based on evidence quality D, with all these safeguards, you are able to assure your minor adolescent patient that her sensitive information will not be released to her parents without her permission. You encourage her to discuss her health with her parents. However, if she cannot, you can still provide confidential care for her reproductive and mental health.