- The Washington Times - Tuesday, May 21, 2002

Dr. Leslie Walker walks an ethical tightrope. As a specialist in adolescent medicine at Georgetown University Hospital in Northwest, Dr. Walker tries to best serve her teen-age patients while respecting the role of their parents. Because District law provides specific confidentiality standards for minors, this can be a challenge.
"Communication between child and parent is the most important thing," Dr. Walker says. "There are times a behavior is so detrimental to the teen-ager that you have to work hard to find a way to get a teen-ager to disclose the information to the parents."
Although minor-consent laws that define the confidentiality relationship between physicians and teens vary from state to state, many family doctors and pediatricians find themselves in the same difficult circumstance of attempting to treat teen-age patients who may not want to disclose medical information to their parents. Most physicians say dealing with this dilemma is a careful balancing act and that some level of privacy is beneficial to teen-agers.
Many times, the law is on the side of the teen-agers, Dr. Walker says. In the District, she says, a minor has the right to be treated confidentially as an outpatient without consent of a parent in regard to matters such as sexually transmitted diseases, birth control, pregnancy, mental health issues and substance abuse. If teens come to her with issues involving suicide or homicide, she must report that to the proper authorities.
Dr. Walker says the statutes often help her perform her job more effectively. Some minors would not tell physicians certain parts of their medical history if they thought the information would reach their parents, especially when dealing with birth control and sexually transmitted diseases.
"It's still better to treat their problem instead of letting them go because they won't tell their parents," Dr. Walker says. "If a child is adamant, I do not override that because then I will lose the patient. Then they won't tell their parents or see me, but over time, you can work with the kids to have more open communication."
If teens don't want to discuss certain matters with parents, Dr. Walker often suggests approaching other family members, such as a grandparent, aunt or uncle. She also offers to counsel teens in a meeting with their parents.
Teen-agers who have good relationships with their parents usually do better in school, Dr. Walker says. They probably also are involved in less sexual activity and substance abuse. For this reason, she always tells parents to be patient with teens.
"Try to be open to what they say without immediate judgment," Dr. Walker says. "For teen-agers, parents are very important."

Leonard Baker, 18, who is in the 11th grade at Frederick Douglass High School in Baltimore, says he discusses everything with his mother. She often accompanies him to the doctor's office.
"She helps me understand women more," he says. "She helps me understand these young ladies today."
Unfortunately, not all teen-agers have open relationships with their parents. Elise Bryson, 16, who also is an 11th-grader at Douglass, says she would rather talk to her friends about personal matters than discuss them with her parents.
"I feel uncomfortable sometimes depending on what questions [doctors] ask," Elise says. "I wouldn't want my parents to be in the room when we discuss sex. Some parents get mad because their child is pregnant. If I was a parent, I would feel mad if my child was pregnant or doing drugs."
Jamal Barnette, 18, a 12th-grader at Douglass, says a doctor and patient should be able to talk about certain details without having a parent in the room. He believes that allows for a more honest relationship with the doctor. Regardless, he says he still values his parents' input.
"They know right from wrong," he says. "They have experienced it before. They may have dealt with the issue. It's good to talk to your parents about a lot of things."

Susan Alexander Yates of Falls Church, who wrote "And Then I Had Teenagers: Encouragement for Parents of Teens and Preteens," says it concerns her that most teen-agers need to receive written permission to take an aspirin in a public school but may receive medical services such as abortion in certain states without their parents' consent or notification. It troubles her that the law enables doctors to discuss touchy topics and perform debated procedures without including parents. She is a mother of five children ranging in age from 23 to 30.
"As a teen-ager, they are still a child," Mrs. Yates says. "They are legally under your roof. You're probably supporting them financially. Teen-agers often make decisions they later regret. It's a huge mistake to not include the parents."
Dr. Walt Larimore, vice president of medical outreach for Focus on the Family in Colorado Springs, says the larger issue is not a physician's responsibility to teen-agers, but to the parents. Before taking his current position, he worked as a family physician for more than 20 years.
As teen-agers grow and mature, they should be allowed to have private conversations with doctors, Dr. Larimore says, but this should be done without disrespecting the parents, especially because parents often are more aware of the family medical history than teens.
"I believe that parents have the right to know about the diagnosis and treatment to then assist their child in the decision-making process," Dr. Larimore says. "Our job as doctors is to assist parents in raising their children, not to replace parents. I see no advantage in skirting parental notification."
Because Dr. Larimore is aware of the minor-consent laws in various states, he advises parents to use care in choosing the family doctor they originally allow to treat their children. He suggests finding out what the doctor believes about contraceptives for minors, sex before marriage and abortion.
During his time as a practicing physician, Dr. Larimore says, anytime he has seen a case of child abuse, the laws governing those violations protected the child. He says he did not need minor-consent laws to help him act in the best interest of a teen who was abused.
In fact, he says, without required parental notification, a girl who is the victim of sexual abuse can have multiple abortions without ever having to reveal that a family member is harming her. She can have abortions in secret and not have to confront the person abusing her, and the abuse could continue.

Despite concerns about minor-consent laws, Dr. Carol Ford, director of the adolescent medicine program at the University of North Carolina at Chapel Hill, says research shows that private health care is important to teens.
In 1999, Dr. Ford conducted a study as part of the National Survey of Adolescent Health. She found that in the previous year, about 19 percent of middle school and high school students across the nation had not received the health care they said they had needed. When asked why not, 12 percent said they did not want to tell their parents. Other reasons included insurance issues and not being able to get to the medical appointment.
"Some things matter so much to teen-agers that they might not even get health care if they can't get it in a private way," Dr. Ford says. "Or they might not tell the doctor what's going on if they can't get it in private."
Dr. David Kaplan, chief of adolescent medicine and professor of pediatrics at the University of Colorado and Children's Hospital in Denver, says there are times when he performs laboratory studies, such as pregnancy tests and tests for sexually transmitted disease, without billing the teen or the insurance company to keep the procedures confidential. Because teen-agers usually use their parents' insurance, he says billing a procedure to the insurance company reveals portions of the teen's medical history to the parents.
"It's better for the parents to know, but that often takes time and negotiation," Dr. Kaplan says. "The parents have to trust that the physician is working in the best interest of their son or daughter."
Dr. Jonathan Klein, associate professor of pediatrics at Golisano Children's Hospital at Strong, part of the University of Rochester Medical Center in New York, says he always emphasizes to parents that teens eventually become adults and need to make decisions on their own. Dr. Klein is a member of the Committee on Adolescence with the American Academy of Pediatrics, which has offices in Northwest and Elk Grove Village, Ill.
The academy recommends that doctors spend some time alone with a patient during every visit starting at age 11. Dr. Klein says he rarely finds a parent who refuses to leave the room when the doctor asks for a private moment with a teen-age patient.
"Then, I say, 'When do you think your teen will be able to make these decisions for themselves? How can I help you prepare for that?'" Dr. Klein says. "You have to allow your teen to have an independent identity."
Rosemary Scholl of Fairfax City allows her children to have private moments with physicians during doctor visits, but she doesn't believe they should make any major decisions without consulting her. She says parents have more of a vested interest in their children than doctors. Her children are ages 21, 16, 12, 10 and 8.
"It's absolutely wrong," she says. "As a parent, we're paying for the medical treatment, and we're not [privy] to the information. You're still responsible for their decisions. They are still under our supervision. It affects their life and health. Slowly, it's taking away parents' rights."


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