Why confidential time with teen patients is necessary

Stephanie A. Grilo, MA, MPhil

Teenagers lack private time with their physicians, according to a new report, raising concern that adolescents may not have adequate time to talk privately with their doctors about sensitive issues and that this could prevent them from getting the care they need.

The report, published in the Journal of Adolescent Health, reviewed more than 1900 surveys from young adults aged 13 to 26 years about their experiences with healthcare providers. A little more than half-55%-of females, and 49% of males reported ever having private time with their physicians, and 55% of females and 44% of males had the opportunity to speak confidentially with their doctor.¹ A third of 23- to 26-year-olds reported never having a private discussion with a doctor, the report notes.

Stephanie A. Grilo, MA, MPhil, a PhD candidate in Sociomedical Sciences at the Columbia Population Research Center, Columbia University Mailman School of Public Health, New York, New York, led the study, and says the researchers’ findings were concerning given professional guidelines that recommend teenagers and young adults have access to confidential services and time for private discussions with their physicians starting at age 13 years.

“When broken down by age group, the numbers are even more alarming,” Grilo says. “Only 22% of 13- to 14- year-old women and 14% of 13- to 14-year old men had ever had private time with a healthcare provider. Even among young adults, only about two-thirds of young adult women (68%) and men (61%) had ever experienced private time with their provider.”

Why private time is important

According to the report, teenagers who reported having private time with their physicians were older, came from households with higher incomes, engaged in higher-risk behaviors, and were the same sex as their physician. Young adults who did have private time with their doctors reported more positive attitudes about their healthcare providers and were more willing to discuss sensitive topics with them, according to the report.

“Private time and confidentiality are critical because when confidentiality is not assured, adolescents and young adults are less willing to discuss sensitive topics with providers or may skip care altogether,” Grilo says. “This is especially true for young people who report behaviors or psychological distress-therefore the most vulnerable may not be getting care.”

Whereas the study didn’t investigate specifically why teenagers aren’t getting private access to their physicians, researchers suggest that clinician comfort may play a role. Suggesting private time may be a challenge for healthcare providers, but Grilo says they need to make clear the benefits of confidential conversations with young patients.

“Parents want their adolescent to be healthy. Parents need to know that private time and confidentiality are important parts of keeping teenagers healthy and they should be asking for this as it will improve the health of their adolescent,” Grilo says. “Parents worry about their adolescent engaging in risk behaviors. Private time allows for proper screening, counseling, and testing, which are recommended by care guidelines. These practices ensure that teenagers who are engaging in risk behaviors have a chance to stay as healthy as possible.”

Positive results of private time

Teenagers who are able to have time alone and confidential conversations with providers have better attitudes about preventive services, Grilo notes, and are more likely to be honest with providers and seek medical help when they need it. Providers should work to make parents and young adults comfortable with having private time with their doctors, Grilo adds.

“On the provider side, we need to make sure we are training everyone to do this well-to introduce private time and explain confidentiality to parents and adolescents,” she says. “Providers should introduce private time at earlier ages to begin making adolescents and their parents comfortable with the idea, and should make clinic policies around age that private time should begin so that providers can point to the policy to help them uniformly provide private time to their adolescent patients. We also need to create accountability measures so that we know where and when we are doing this well and where we can improve.”

References:

1. Grilo SA, Catallozzi M, Santelli JS, et al. Confidentiality discussions and private time with a healthcare provider for youth, United States, 2016. J Adolesc Health. 2019;64(3):311-318.