This sort of scenario is not uncommon in an office practice. The physician's initial approach was to establish a therapeutic alliance. However, the physician was not successful in achieving a therapeutic alliance. Therefore, it is appropriate to review with the minor the limitations of confidentiality and share with them what information may be made available to parents. Exceptions to confidentiality include cases of medical emergency, danger to self or others, childhood abuse or court-ordered evaluation in which the physician is obligated to provide information to a judge.
Parents also have access to general medical information without the patient's permission.
An exception is information about substance abuse evaluation and treatment, which is protected by confidentiality regulations under federal law. Therefore, information about substance abuse of a minor patient can be released to a third party, including parents, only with a patient's written consent. Primary care physicians should know their state statutes about confidentiality governing the care of minors and reporting of infectious diseases. Consent from the mother for evaluation for HIV and syphilis would have been appropriate. In addition, a urine drug screen may have been helpful for future management of this patient.