At the Center, we talk a lot about how our care is free and confidential.
The importance of accessible health care is somewhat obvious: Health care is necessary to live a healthy life, and if you can’t get it your quality of life will deteriorate. But confidential health care is also key to living healthily, even though the reasons may not be as immediately clear.
So what does confidentiality mean?
Confidential health care means that your doctor cannot reveal any of your personal health information to anyone unless you give explicit written permission. This includes diagnoses, tests, procedures, or even the fact that you’re a patient. However, confidentiality gets a bit tricky when you’re a minor. If you’re under 18 years old, you need your parent’s permission for most medical care, with several major exceptions.
Why do adolescents in particular need confidential care?
Confidential health care is important for everyone, no matter their age. Patients need to be able to talk to their doctor about personal and potentially uncomfortable issues without fear that others will be notified. This is especially true of more private or stigmatizing diagnoses, such as mental health disorders or sexually transmitted infections (STIs).
Confidential health care is very important for adolescents, who are becoming more independent and learning to make their own medical decisions. Young people need to be able to talk openly with their doctor about topics they may feel too uncomfortable (or unsafe) to bring up with their parents: sex, relationships, drugs and alcohol, their changing bodies. Teens are more likely to discuss confidential subjects if their provider explicitly says that their conversation is confidential. Confidentiality also makes teens more likely to access reproductive health (and other) services, free of the fear that they will get in trouble with their parents.
Health care providers will almost always encourage adolescents to discuss their concerns and questions with their parents. This can be an opportunity to strengthen lines of communication and build a stronger relationship. At the same time, being able to consent to their own care gives teens needed practice in managing their own health so that they are better prepared to live independently.
What health care is confidential for minors?
It depends on what state you live in. In New York a minor can consent to reproductive health services (including access to birth control, Plan B, prenatal care, STI testing , most STI treatments and abortion), certain mental health services (including alcohol and drug abuse counseling), and treatment for sexual assault. If a minor clearly understands their diagnosis and treatment, health care providers may decide that they are mature enough to consent to other types of health care as well.
If you live outside of New York, here is a handy chart that covers the basics of what care minors can consent to in each state.
Are there exceptions?
Yes. If a health care provider thinks anyone’s life is in danger, they are obligated to report it. This includes suicidal or homicidal ideation, self-harm, and evidence of abuse. There are unique rules surrounding confidentiality and treatment for HIV, which ultimately rest on whether the patient can effectively manage their own treatment regimen, and whether revealing their HIV status will make them unsafe or impede their care (such as reporting to abusive partners or parents). In addition, health care providers are obligated to report initial positive HIV results to the New York State Commissioner of Health, and to notify any known sexual partners or needle-sharers (though you are not obligated to reveal these names to your provider).
The laws surrounding HIV disclosure can get complicated, and general confidentiality laws for minors differ based on whether they’re married, have a child, are emancipated or are in foster care. This guide from the ACLU does a pretty good job explaining the particulars.
There are also some practical issues with keeping confidentiality. If a young person is still on their parents’ health insurance, their parents may receive a medical bill that reveals tests, procedures or appointments. Because of this, teens may seek out free clinics or health care providers which use a sliding scale for payment, such as Planned Parenthood.
What happens when confidentiality is not protected?
Without confidential care, teens are less likely to get necessary reproductive health services. One study found that over half of adolescent girls surveyed would put off getting STI testing and treatment or stop using at least one reproductive health service if their parents were notified. Fear of parental notification already results in teens not getting the health care they know they need. New cases of gonorrhea and chlamydia appear most commonly between the ages of 15 and 24. Because these infections often don’t present with symptoms right away, it is especially important that teens and young adults get STI testing routinely. Ensuring confidentiality is one way to increase the likelihood that teens get tested and receive all the comprehensive health services they need.
A version of this post was originally published in September, 2016. It was written by Sari Bentsianov, MD, who at the time was a fellow in Adolescent Medicine at the Mount Sinai Adolescent Health Center. She received her pediatric training at the Children’s Hospital at Montefiore in the Bronx and her medical degree from Temple University in Philadelphia, PA. She has a strong clinical interest in Adolescent Gynecology and provision of reliable contraception. She believes the best way to provide quality health care for teenagers is to break down barriers to care and advocate for teens in the community in which she practices.
The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.