By Carolyn Crist
(Reuters Health) – Most parents believe their adolescents should spend time alone with the pediatrician during routine visits to talk about any concerns or questions, according to a new study.
“Kids don’t always disclose their health information to doctors and parents, which means they try to negotiate serious health issues without a trusted adult,” said Dr. Melissa McKee of Albert Einstein College of Medicine in Bronx, New York.
McKee, who wasn’t involved with this study, has researched the challenges of providing confidential care to adolescents. Teens are more likely to seek health care and openly talk to doctors when they’re assured of privacy, particularly for issues related to sexual behaviors, substance use and mental health.
“Kids need a trusted adult as they transition from a setting where health decisions are typically made for them to adulthood when they’re completely in charge of their own health,” she told Reuters Health by phone.
Researchers at the Children’s Hospital of Philadelphia surveyed 91 parents and teens ages 14 to 17 who attended a routine wellness visit with a pediatrician. During a follow-up phone call two weeks after the visit, parents reported whether their child met with the pediatrician alone, rated the importance of alone time and talked about the barriers of adolescent-pediatrician communication.
Ultimately, 86 percent of adolescents had time alone for part of the wellness visit, ranging from five to 30 minutes. Fifty-three parents, or 58 percent, said this private time had “a lot” of importance, and another 25 parents (27 percent) ranked it a bit lower but still said it had “quite a bit” of importance. Parents of males were almost twice as likely to agree that alone time with the doctor was important. Parents also said communication barriers included rapport and familiarity with the pediatrician, privacy concerns, emotional comfort, trust and support.
“We need to start creating opportunities for kids to have autonomy with regard to health issues,” McKee said. “It’s not all or nothing at a certain age. They don’t suddenly become fully in charge of themselves.”
Future studies should focus on the gender difference, McKee added. She and colleagues found that moms with daughters, in particular, were nervous about losing the leadership role in health decisions and didn’t want their daughters to be exposed to certain topics related to sexuality.
“Some mothers believed certain conversations might even be a green light for (their daughters) to be sexually active,” she said. “The gender difference is a consistent pattern we see.”
To battle the barriers to communication with teens, some pediatricians implement mandatory alone time early and build it into annual visits as patients approach their teen years.
At age 10, for instance, doctors can begin talking to children about privacy and confidentiality in health care settings. Then at ages 11 and 12, kids can consider whether they’d like alone time with the doctor. By the teen years, pediatricians can build mandatory time into the visit, even a few minutes with the parent out of the room, said Dr. Joe Hagan of the University of Vermont College of Medicine in Burlington, Vermont.
Hagan, who wasn’t involved with this study, co-authored Bright Futures, a national health promotion and prevention initiative of the American Academy of Pediatrics, includes a section about the ways doctors can discuss privacy and confidentiality with children, as well as begin to build alone time into their appointments.
“If doctors in the same office are willing to set up mandatory alone time, it’s easy to move forward,” Hagan told Reuters Health by phone. “When everybody does it together, parents know to expect it and aren’t caught off guard.”
SOURCE: http://bit.ly/2yjsq2t Journal of Adolescent Health, online June 7, 2018.