Discussion: Provider–Patient Confidentiality With School-Age Children And Adolescents

When treating pediatric patients in clinical settings, you also treat patients’ families. With younger patients, this tends to be a seamless process. However, as patients age and grow into the adolescent years, the provider-patient-family relationship becomes more complex. The change in this dynamic often creates questions in provider-patient confidentiality. As the advanced practice nurse providing care for school-age children, adolescents, and their families, how do you handle these confidentiality issues? If a child is a minor, do you have to maintain provider-patient confidentiality? When is it appropriate to allow patients privacy? When is it your legal and ethical duty to involve family members? How do you facilitate the care of a minor when you have to work with parents and still maintain patient trust?

Consider the following three case studies.

Case Study 1

You receive a phone call from a mother who is concerned that her son is using drugs. The 16-year-old boy is seeing you in the afternoon for a follow-up for acne. The mother requests that you obtain a drug test during the visit, but she does not want her son to know he is being screened or that she requested screening because “I don’t want him to stop trusting me.”

Case Study 2

A 17-year-old girl comes to your office with a complaint of abdominal pain and missed periods. She thinks she may be pregnant. She requests pregnancy testing and does not want you to tell her parents if she is pregnant.

Case Study 3

The father of a 10-year-old boy calls your office to request assistance with an Individualized Educational Plan (IEP) for his son who was recently diagnosed with attention deficit hyperactivity disorder (ADHD). He wants you to contact the school and to facilitate getting an IEP developed.

To prepare:

• Review this week’s media presentation, as well as “Developmental Management of School-Age Children” and “Developmental Management of Adolescents” in the Burns et al. text and the Schapiro article in the Learning Resources.
• Think about confidentiality laws regarding providers, school-age children, adolescents, and their families.
• Select one of the three provided scenarios. Reflect on the provider’s role and responsibility regarding confidentiality between the patient and the patient’s family in the scenario.
• Consider the appropriate way for the provider to respond and facilitate the care of the patient in the scenario you selected. Think about interventions and strategies that the provider should use to address the issues presented.