Confidentiality and Treating the Adolescent Patient.

HILTON HEAD ISLAND, S.C. -- Adolescent patients and their parents deserve a straightforward explanation about a patient's right to confidentiality and the circumstances under which that confidentiality may be breached, Dr. Tomas Silber said at a pediatric meeting sponsored by Contemporary Forums.

A written or verbal contract can be useful for setting forth the concept of confidentiality and establishing the patient's trust, said Dr. Silber, director of the Office of Ethics at Children's National Medical Center in Washington, D.C.

The contract should be age appropriate. A younger adolescent can simply be told that whatever is discussed with the physician will be kept private unless something happens to endanger the child's health. An older adolescent can be told about the specific circumstances under which confidentiality may be breached.

These circumstances include when a patient has suicidal or homicidal tendencies, when physical or sexual abuse is suspected, and when a patient has a dangerous condition such as an eating disorder or substance abuse problem.

"It has been shown that explaining this will not eliminate these issues from a conversation with the physician. These matters will be revealed to you anyway," said Dr. Silber, who is also professor of pediatrics at George Washington University in Washington.

In the event that it's determined confidentiality should be breached, it's important to involve patients in the process of sharing information. Find out first whether patients wish to share the ...