But what of her mind and soul? Adolescents are ready to challenge authority (i.e., Mom) and take physical and emotional risks as they find themselves.
One day, that teenage girl may come in and, while sitting casually on the exam table, make a request, as a patient of mine once did a few years ago, and say, “I need a pregnancy test.”
A pregnancy test is not something most teen girls want their mothers (or fathers) to know they’ve taken. But in a world where many girls are sexually active by the time they turn 18, it’s not an unusual request. What gave me pause this time was that the girl asked me with her mother sitting in the room.
“Are you sexually active?” I asked.
“No, but my family wants me to have the test because I have a boyfriend.”
Biology, ritual (the bat mitvah, the quincinera) and the law tell us when a girl becomes a woman, but in the doctor’s office, the line is less clear. In today’s pediatrician’s office, girls are often counseled like women beginning at age 11, the age when the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend vaccination for human papillomavirus, which is typically passed during sexual activity.
All states have laws that allow teenagers to receive confidential medical care under sensitive circumstances. In California, where I practice, teens, beginning at age 12, are allowed privacy for, among other things, counseling about birth control, testing for and treatment of sexually transmitted infections, and pregnancy. For me to violate that confidentiality risks prosecution and the loss of my medical license.
“Why don’t I show you where the restroom is so we can get your pregnancy test?” The girl followed me out of the room. I took a quick detour with her into a quiet corner of the office. “I want to ask you privately: Are you sexually active?”
“No.” I sent her to the restroom and asked my medical assistant to run the test.
Teen confidentiality laws and practices have the best intentions, and whatever your social mores, the evidence is clear that they’re best for the health of the adolescent. But putting those laws to work can get messy.
I practice and live in a community where many parents feel the need to hover a little too closely over their offspring. This is especially true when it comes to talking about sex. When I broach the subject — whether to talk about getting a pregnancy test, offering birth control or testing for sexually transmitted diseases — some parents refuse to leave the room. But even if the teen requests a private consultation with me, I cannot force the parent to comply; I can only ask the teen to contact me separately at another time.
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