We give the written policy at the start of the adolescent visits so parents know ahead of time what to expect. With continuity the adolescent has come to have a relationship with the physician and can communicate. Have adolescent call-in hours and set up rap group for teens to discuss issues. It helps when the physician explains the details and the reason behind the exam. The level of maturity and stage of adolescence can be more important that the chronologic age.
Teenagers feel more comfortable and less likely to disturb patient flow.
This helps prepare everyone and creates less uneasiness for later physical exams. Then I speak with and examine the patient alone. Then bring parent back and discuss all non-confidential issues so patients see I m not divulging information. It takes more time, but overall is more efficient because all voices are heard. Explaining what is going to be done often helps to have the teen be less apprehensive.