I start the visit with the parent in the room, but address the teen & encourage them to answer (I’ve shushed chatty parents but only when I know them very well). Parent can chime in later or prn. During genital exam, I let teen choose their chaperone - parent or my MA/nurse. 2/pic.twitter.com/SRfSEd0kTb
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After that, I have the chaperone leave & chat (LISTEN!) with the patient alone starting with the confidentiality spiel... convo is private unless revealed that someone is hurt or will be hurt. This process is spelled out in a handout parents & teens get when they check in. 3/pic.twitter.com/Q041mlABIU
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If there is something I think the parent SHOULD know, I ask the teen’s permission to discuss it. If they decline, I honor it. If the parent NEEDS to know, then I let teen decide who tells parent - them or me. 4/pic.twitter.com/bo7h6cr7CN
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So how do parents & teens feel? In this study, 89% of parents agreed that teens should talk to their doctors alone. Half of the teens felt parental presence impacts the conversation. More health topics were covered when teens had the confidential chat. 5/ https://www.ncbi.nlm.nih.gov/m/pubmed/25043835/?i=23&from=/29887486/related …pic.twitter.com/WYdQVDwYHN
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This is another more recent study (2018) and still more than half of parents surveyed thought it was important for their teens to have talks alone with their doctor. 6/
#tweetiatrician#medtwitter#somedocs https://www.ncbi.nlm.nih.gov/m/pubmed/29887486/?i=1&from=/29887486/related …pic.twitter.com/rhEHzlWcdwPrikaži ovu nit -
This study shows that once parents rec’d education (clinic policy & nat’l stats on risky teen behaviors) the confidential conversation with their doctors, 50% parents changed their negative opinion about it to a positive/supportive one. 7/ https://www.ncbi.nlm.nih.gov/m/pubmed/16199709/?i=3&from=/29887486/related …pic.twitter.com/jtny74rpvk
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In that study, 2/3 of the parents had a favorable opinion about teen privacy in the doctor’s office. Again, a MAJORITY of parents support this. & once they understand why it’s important, even more support this STANDARD of care. Now.. what if the parent still refuses to leave? 8/
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First, know state law. In PA, a minor can consent to contraception & STD testing care except for abortion (but can get confidential court hearing to get override). Minors 14+ can consent to inpt & outpt mental health care. 9/
@pa_aap@PAMEDSocietyhttps://www.aclupa.org/en/reference-card-minors-access-confidential-health-care-pennsylvania …Prikaži ovu nit -
And if parent refuses to leave (happens to me about once every 1-2 years), then I just document that in the chart. I can only try my best.
10/fin #tweetiatrician#momlife#dadlife#somedocspic.twitter.com/rWO0SOdn1RPrikaži ovu nit
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I have always stayed. As my son turned 18, sent him on his own to clinic. Sent home, no follow-up tests, despite severe abdominal pain, nausea, & blood in urine. History of testicular torsion surgery. pt1.
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Absolutely agree that it is a balance of autonomy & advocacy. That’s why we start so young to help the teens develop independence - what’s important to tell the doc & how to remember follow up plan. I quiz them, too, & make them write it in their phone. 1/2
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