Every once in a while a parent will tell the nurse that they want the child out of the room to discuss an issue with the doctor privately. This is usually something they perceive as a negative thing for the child to hear. Some of the most common concerns are about the child’s weight or behaviors. Sometimes it relates to a change in the family dynamics, such as divorce or a parent having a significant illness.
Secrets should never be kept…
While I understand the parent’s intentions, I find this to be disruptive and counter productive. As much as I try to find an excuse to have a child leave, it is usually obvious that the nurse keeps them out longer than needed.
If we have the child leave the room, he knows something is up. We are talking about him.
But not sharing with him.
What could possibly be so bad that we won’t talk to him about it?
How do you feel when you suspect people are talking about you?
Why then should parents and doctors keep things from the child?
That doesn’t mean kids need to know everything.
We all know that as adults that we do shield our kids from things.
Kids do not need to know our financial worries. We can teach them financial responsibility without increasing their anxieties.
They do not need the burden of knowing about extramarital affairs. If there are problems in a relationship, they will know there are problems, but they do not need to know details.
I don’t think that kids need to know everything, but that doesn’t mean that we should make it obvious that we’re hiding something. Especially when it pertains to them.
What does the child know?
Any patient needs to know what the issues are so they can be addressed. This includes most kids.
My guess is most of these kids already know what the concerns are.
They may need help working on the concern or help adjusting to the home life situation.
If they are overweight, we need to talk about what they eat, how they exercise, and how they sleep.
When there are behavior problems, they need to give insight into how they feel and what leads to the behaviors.
Regardless of the issue, they need to be a part of the plan to fix the problems. If they aren’t on board, they won’t change their habits. I can talk about weight (or behavior, or drugs, or whatever the concern is) sensitively and in an age appropriate manner with the child. The kids at school are likely talking about it in a not-so-sensitive manner, so it’s best to not make it worse by secretly discussing it.
What if it really needs to be said?
If a parent really wants to let a physician know specific points without the child present, there are ways to do that without making the child feel left out.
Send in a letter or secure electronic message with your concerns before the appointment. Be sure it’s at least a few days before the appointment so the doctor has a chance to review it!
Schedule a consult appointment for just parents to come in without the child.
Call in advance to note your concerns so the physician can address it as needed during the visit.
Slip a note in with all the paperwork you’re turning in during check in so the physician can read it before coming into the room. Be sure whoever you give it to realizes it’s included with the standard paperwork so they can pass it on.
Don’t bring siblings to an appointment where you want to discuss a private matter with your child.
All of these help the physician know your concerns without blatantly kicking a child out to talk about something privately.
Teens are at a time of life that they need to develop independence. They need to master several things before leaving the nest, such as how to manage time, cook a simple but healthy meal, do simple home repairs, spend and save money wisely, and how to live with healthy habits. Allowing them to grow more independent with each passing year can help prepare them for life on their own. This includes letting them take charge of their healthcare in late teen years.
Independence at the doctor’s office
One important skill includes relying less on parents when they’re at the doctor’s office.
You don’t want them to show up at another health clinic for treatment without knowledge of their medical history. This is especially true for chronic issues, medications and drug allergies. Let them help fill out the paperwork and answer the questions from the nurse and doctor.
Teens need to learn how to summarize their concerns so the doctor can make a proper assessment. If parents do all the talking, they don’t learn how to do it themselves.
Questions, questions, questions!
Most parents have the best interest for their children at heart when they answer questions and want to be in the room for their teen’s visit. But if you really want to help them, it’s best to let them take more responsibility each year.
As kids get older, they should take more responsibility filling out forms and answering questions. They should even have an opportunity to spend time alone asking private questions.
Parents speak up then sit back.
We certainly want to hear parental concerns, but a teen should be allowed to do most of the talking. Over time this allows them to eventually visit a physician alone competently.
They will then be able to take care of their health when they move away from home and establish care with an adult doctor.
If they don’t know their medical history, current medications, allergies, or simply how to talk to a medical provider, they won’t be able to take care of themselves.
You won’t realize how much they don’t know unless they try to handle it themselves.
Let them fill out forms and ask if they need your help. You’ll learn what they don’t know and you can inform them as well as find a place for them to store that information for next time.
As kids get older, they need some time alone with the doctor at least yearly.
Even if they have nothing to hide, it’s a good idea to allow teens some private time alone with the physician. This allows them to develop a trusting relationship with the doctor. If something personal and private does develop, they are comfortable talking with that physician. This is one reason I strongly encourage a well visit once a year with the same person as much as possible. Routine visits allow a healthy doctor- patient trust to develop.
It’s hard as a parent to not know everything that your child talks to their doctor about. I know – I have two teens. And to complicate things, I work in the same office as their physician. I never ask her about my own kids unless I’m still in the room with them. I trust that she will take care of my kids and help to direct them into healthy healthcare decisions.
Teens should understand that they can talk to their physician openly without fear of judgement. While it is possible that the physician might ask to share the information, they usually will not if the teen does not allow it. Teens should be aware when the confidentiality will stand and when a physician must share their concerns. Most physicians will attempt to maintain the trust of a teen so that they will continue to discuss difficult health concerns. If the physician is afraid that the teen is at risk of being hurt or of hurting someone else, things change. We must ensure safety. This will mean other adults will learn of the issue, but the teen will be told first.
“But I’m the parent. I have a right to know.”
Many parents feel this way, but the reality is the law protects a teen’s privacy. Even when the parent carries the insurance and pays the bills, teens have the right to privacy.
And for good reason.
The problem is that if our kids don’t feel confident that the doctor will maintain confidentiality, they will not tell us important things that can help us help them. If they’re afraid to say that they’ve started vaping or that they are considering becoming sexually active, we can’t help them make smart and safe choices.
If they hide symptoms of an illness, whether it’s a sexually transmitted disease or depression, they won’t get the help they need.
We need them to be able to tell us those things that they don’t want their parent to know. It’s not that we want them to do these things, but we need to be able to help them stay as safe and healthy as possible.
We want them to talk with you, and you can certainly foster that at home. They still need to be able to be completely open with their physician without the threat of a breach of confidence.
Be careful of assumptions.
It is natural to fear the worst if your child wants to talk to the doctor privately, but in the majority of cases it’s all pretty benign stuff that they want to talk about.
You will of course get bills from the insurance company that might suggest certain diagnoses or tests. We cannot verify or deny why those charges occur.
Don’t assume your child is having sex just because a pregnancy or STD test is done. There are many criteria that flag when a teen should have testing. Remember that guidelines are developed to not miss situations, so they are broad. For instance, many girls will get a pregnancy test done before certain procedures, even if they deny being sexually active. This is because we know that some kids lie and we don’t want to put an unborn child at risk, so all girls of a certain age will be tested before the procedure.
Despite the fact that I will maintain confidentiality as required, I usually attempt to talk teens into talking to their parents.
If the teen agrees to us telling their parent together, it usually ends up bringing them closer as a family. This requires that the parents are able to not judge or punish a child for his or her decisions.
Teens often feel uncomfortable discussing it initially, but once they know that parents know whatever it is, they are often relieved. If the parent accepts the situation without harsh judgement, even if they are disappointed in their child, they can learn to work on things together.
If the parent responds inappropriately, it can damage the relationship. As with anything, if you can’t say something supportive, don’t say anything other than, “thank you for sharing. I need some time to think.” Give yourself time to reflect what you learn and then prepare what you will say.
They still might make bad choices.
Even with confidential communication, teens still will make bad choices.
The teen brain is well known to be impulsive and to not recognize consequences. We all know good teens who make bad choices. Caring adults will attempt to help the teen make smarter choices, but no one can change a teens behavior except the teen.
Be sure your teens know that you love them unconditionally. This will help them feel more comfortable coming to you if they need to talk. Let them know your expectations for behavior. If they open up to you about problems or bad situations, listen without judgement and offer help and support where you can. Be supportive and help them find ways to bring about positive change. There can be negative consequences, such as taking away their phone or not being allowed to go to a party, but do not belittle them. Belittling shuts the door of communication and they might not open it again.
We know that teens have not established independence from parents fully. Teens usually still live under your roof and must abide by your rules. Parents usually support teens financially. But teens also are legally protected to be able to talk about sexual health, their feelings, and more without concern that parents will be told what is discussed.
There are exceptions to this confidentiality, which varies by state law. Typically if the teen is being abused, is involved in non-consensual sex, is at risk of self harm or if they are at risk for hurting others, the physician must notify others.
Watch them grow…
Parenting has its challenges, but in the end most parents want their kids to be healthy, happy, productive members of society. In order for this to happen, they have to allow their kids to gain a little more independence and accept a little more responsibility each year.