Confidentiality and Minors

Background A 14 yr. old female presents to your office requesting an evaluation for a persistent foul smelling vaginal discharge. When the results of her G.C. culture come back positive, you call her home and her mother answers, she quickly becomes very angry and threatens to sue you for treating her daughter without her permission. For those of us who care for women who have not yet reached the age of majority, situations similar to this occur all too frequently. We cannot possibly provide the best possible care to our minor patients if we do not have a clear understanding of the laws related to their care and confidentiality. Methods A twelve question survey was developed in a case scenario type format. Confidentiality issues as they related to the care of minors included, risky behavior, SID's, teen pregnancy, abortion issues, and HIV. The questions and answers were based on a careful review of the Pennsylvania minor consent and confidentiality laws and were further confirmed by an attorney review. The survey was then distributed to attending physicians and residents actively involved in the practice of OB/GYN and Family Practice from four different local medical centers in Northeastern Pennsylvania. Results A preliminary total of 72 respondants including 20 OB attendings, 22 OB residents. 1 OB Physicians Assistant, 8 Family Practice attendings, and 21 Family Practice residents. Ten of the OB attendings were in practice for less than 15 yrs. and had a combined total wrong of 29/120 (24%); ten of the OB attendings were in practice for greater than 15 yrs. and had a combined total wrong of 33/120 (28%). Six 1st yr. OB residents had a combined total wrong of 20/72 (28%); Five 2nd yr. OB residents scored 18/60 (30%); Five 3rd yr. OB residents scored 22/60 (37%); and six 4th yr. OB residents scored 17/72 (23%). The eight Family Practice attendings have all been in practice for less than 15 yrs. and had a combined total wrong of 30/96 (31%). There were eleven 1st yr. FP residents who had a combined total wrong of 38/132 (29%); five 2nd yr. FP residents who scored 20/60 (33%); and five 3rd yr. FP residents who scored 9/60 (15%). The question missed most often tested the confidentiality of test results and physician-patient privilege, was missed 67% of the time. The second most commonly missed question tested the understanding of abortion laws in this state with regard to a rape victim and was missed 56% of the time. The third most commonly missed question tested which medical conditions involving a minor may be diagnosed and treated without parental knowlege or consent was missed 44% of the time. Conclusions It is obvious from this preliminary study that confidentiality is a commonly misunderstood concept at all levels. Experience in years of practice and or training does not necessarily improve that understanding to any significant degree. If this were just a test, most of us would probably pass with an overall average of 73% but we were wrong 27% of the time. In this litigious atmosphere in which we practice medicine, it is imperative that we eliminate the weaknesses identified by this study and improve our training process with regard to confidentiality issues of adolescents.