There are a multitude of bittersweet milestones a parent faces as their child grows: heading off to preschool, losing a first tooth and that first date, to name a few. However, few parents are ready for the moment their child's pediatrician suggests they step outside the exam room so that their teen can have a moment of privacy with their doctor.
Dr. David Hall, a board-certified internal medicine and pediatrics doctor with Sharp Rees-Stealy Medical Group, recently answered a few questions about adolescent health exams and what happens when parents are asked to leave the room.
At what age do you ask a patient if they'd like mom or dad to leave the exam room?
Our adolescent well-child exams begin at 12 years old. So generally, between the ages of 12 and 14, I begin asking parents to leave the room for a portion of the encounter. This can vary slightly, depending on factors such as age of puberty onset and the maturity of the patient.
What takes place during an adolescent health exam?
I spend time with the patient and the family discussing the patient's health history, including past and current medical issues, medications, allergies, diet and exercise patterns, family dynamics and school performance. I also address any concerns and questions, and then perform the majority of the physical examination with the parent in the room.
Before the sensitive portion of the examination, which would be the testicular examination for boys and breast and pelvic examination for girls (if indicated), I ask the parent to leave the room after obtaining the patient's permission. We complete the examination with a chaperone — usually a medical assistant — present. I then invite the parents back in to summarize the visit findings, provide any follow-up plans, and discuss health maintenance and prevention topics.
What discussions happen between doctor and patient during the exam?
It is important to first let the patient know that nearly everything discussed during this time is confidential and will not be shared with their parents without the patient's permission (except in special circumstances, for example, a patient discusses wanting to hurt themselves or others, or there is an issue of sexual abuse).
During this time, it is crucial to address sensitive issues that are pertinent to adolescent health and that the patient may feel uncomfortable broaching with their parents, including sexual development or activity, drug or alcohol use, contraception and other issues. I may cover topics including home environment, education and employment, peer-related activities, alcohol and drug use, sexuality and sexually transmitted diseases, mental health, and safety from injury and violence.
Should mom or dad speak with their child after this part of the exam, or should it remain private?
Before inviting their parents back into the exam room, I clarify with each patient what they are comfortable sharing and what they would like to keep private. I generally encourage discussion of important issues with their parents. I offer to be present for the discussion if they wish, or we explore approaches the patient might use to facilitate the discussion with their parents in the future.
How should mom or dad support their teen's wish for privacy if they do not want to discuss it?
Adolescence is a period of intense change, and teens often struggle with asserting their individuality while still maintaining healthy relationships with their parents. It is important to respect the teen's wishes for privacy, which can be difficult for many parents who are trying to look out for their child's best interests.
If your teen is reluctant to discuss sensitive issues, encourage them to follow up with their doctor for further discussion. My ultimate goal as a doctor is to build a trusting and supportive relationship with both the parent and the adolescent to foster open communication about health and wellness.