If a child/teenager tells you something in private....

[beatsbydre]

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Are you obligated to tell the parents if the parents asked? This is if the child/teenager is not emancipated. Stuff like drug use, sex, STD, etc.

 

[JoshSt]

All the examples you gave - no. If it is a reportable disease, you report it to the health department but you are not obligated to report it to the parent. If the kid is suicidal or homicidal then you admit them or alert the authorities, respectively.

Ignore this for testing but in most states, the law is written where the physician is protected if they do tell the parent or don't tell the parent. For example, in those states, you could theoretically coerce something out of a kid with a, "I promise not to tell your parents" and tell them anyway and be legally protected. Similarly, if the patient is sexually active or has an STD and something bad happens because of this, the physician is protected legally if they chose not to tell the parent.

For exam purposes, don't tell the parent.

PS - This is mostly for teens, I don't know or can't think of an example of private interview etiquette for a very young child

 

[g8orlife]

Are you obligated to tell the parents if the parents asked? This is if the child/teenager is not emancipated. Stuff like drug use, sex, STD, etc.

No.
We don't want to risk the teen avoiding treatment/care just because he/she wants to avoid his/her parents finding out.

 

[witzelsucht]

For example, in those states, you could theoretically coerce something out of a kid with a, "I promise not to tell your parents" and tell them anyway and be legally protected.

Wow, really? Seems very unethical. Do you have an example of when you would do this? Just curious.

 

[Anastomoses]

Wow, really? Seems very unethical. Do you have an example of when you would do this? Just curious.

Say a 9 yo tells you they've been getting molested? There's a possible occasion.

 

[CDI]

Say a 9 yo tells you they've been getting molested? There's a possible occasion.

That goes under child abuse, completely different situation.

 

[Anastomoses]

That goes under child abuse, completely different situation.

How is that not a situation when you'd trick the child into telling you something?

 

[CDI]

How is that not a situation when you'd trick the child into telling you something?

Actually, I'm not even sure how that conversation would even come up if the parent or legal guardian wasn't aware. You're saying a 3rd party was harming a child, and the kid was afraid of the parents finding out, so you'd lie to get information out of them and then inform the parents? If the child is afraid to tell their own parents, and theres a reason, could you be putting the child in further harm by telling them (before CPS)?

Now if the parent or guardian are the ones at fault and you pulled the kid aside for whats going on. You would get the information from the kid without lying, becuase you would not tell the parents anyways. You'd call CPS and notify the authorities.

It's not like the 9 year old is going to walk into your medical office on their own, so I'm guessing you are referring to the first scenario.

 

[JoshSt]

Wow, really? Seems very unethical. Do you have an example of when you would do this? Just curious.

I can't think of a useful example where it wouldn't be scumbagish.

An example would be something like, a teen has bad gynecomastia or something that makes you suspect he's smoking pot. You butter him up, gain his trust and he admits he does smokes pot and uses ecstasy (in private with the assumption you will not tell their parents via your trust). After the interview, his mom talks to you and says, "I think he's taking drugs, did he tell you anything about that?" (In most states) you're legally protected if you decide to tell the parent. The ethical thing to do would be not to tell the parent and try to encourage communication on both ends. First, encourage the boy to talk about it with his mom and, if his mom asked you this example question, say you can't disclose details about your interview with him but encourage her to talk to him about it.

Continuing with the example, say the kid dies at a rave. If the parents somehow found out you knew that he abusing drugs and they want to sue you for not telling them, you would be legally protected from a lawsuit.

A possible example where you may want to break confidentiality to the parents is if the teen told you he liked to torture animals, maybe you could use judgement and possibly tell the parents and recommend psychiatric care. This is assuming he wasn't suicidal/homicidal where you would be obligated to admit him or report to the authorities.

All the example I gave were in the context of a pediatrician-teen interaction. The psychiatrist-teen interaction would probably have different circumstances and expectations.

 

[CDI]

A possible example where you may want to break confidentiality to the parents is if the teen told you he liked to torture animals, maybe you could use judgement and possibly tell the parents and recommend psychiatric care. This is assuming he wasn't suicidal/homicidal where you would be obligated to admit him or report to the authorities.

Would you be protected from a lawsuit in this example?

 

[JoshSt]

Would you be protected from a lawsuit in this example?

Yes, in most states the law is written so the physician can have the option to do both (in the case of non-emancipated children/teens). It's designed like this so physicians can have freedom and peace-of-mind to make tough decisions in situations where breaking doctor-patient confidentiality may be more beneficial than honoring it. The general recommendation is that physicians do honor confidentiality but, in the case of my theoretical example and other tough situations, it may be more beneficial to the patient if the physician did tell their parents.

 

[VivaLaVida]

I actually think in my state (Iowa) you have to tell the parents if the adolescent tests positive for HIV. We might be the only state with this law though. First Aid lays it out somewhere in the behavioral chapter, but generally you can't tell the parent.