Testimony Regarding Absolute Confidentiality For Teens Regarding Their Medical Care 1

I am Ross Olson, a pediatrician with 4 children and 4 grandchildren. I have practiced for over 35 years, including the US Navy, Pilot City Health Center in Minneapolis, a College Health Service and Emergency Room in Illinois, a Hospital and Clinic in Hong Kong and most recently 23 years with a large HMO here in the Twin Cities.

My opinions arise from my experience and concern for the long term consequences not only to my own patients, but also to all children and adolescents growing up in our increasingly dangerous world.

The idea that teens need absolute confidentiality in their medical care is based on a reasonable assumption, that otherwise they will not seek care. After all, it is hard enough to get them to talk about significant issues anyway. But it does not necessarily work that way and there are serious unintended consequences to the policy, because it is based on a number of unwarranted assumptions.

One is this: It assumed that the average family is dysfunctional. When a 16 year old girl says, "My Mom will kill me if she finds out I am sexually active," the caring professional may downgrade the potential scenario from murder to mild mayhem, but still basically agree that telling the parents would result in nothing good. This means that the professional thinks he or she knows better and cares more for that adolescent than the parent, or perhaps assumes that the teen is completely competent to make these decisions independently.

Yet the parent, for better or for worse, is the parent for life and the professional will be in the picture, at best, for a relatively short term. Thus the policy drives a wedge between parent and child and separates the parents from life-changing decisions whose consequences will affect them regardless.

Another effect of this policy is to promote the illusion that if nobody knows, nothing happened, or that things can be undone as if they never occurred, or even that with proper technology, risky behavior can be made safe. Teens are not good at long term planning and many professionals have the attitude that the best we can do for them is to blunt the effects of their actions. I call this “the animal model of adolescence.” That sort of thinking never considers that there is great value to a high standard – as we now have with smoking – even if many fall short.

Would repeal of total confidentiality leave medical providers in the uncomfortable position being "stool pigeons" with no room for wisdom? When a teen comes in to see me with a concern and says, "Don’t tell my parents," I can say, "Your parents really need to know about this and I think YOU should tell them. I can help you with that."

Finally, unconsidered in the equations of the confidentiality proponents, is the deterrent effect of potential discovery. If we as adults are honest, we will all admit that, at least sometimes, the reason we control our impulses boils down to fear of what would happen if we were found out. A concrete example of this occurred when Minnesota had a parental notification law for minors seeking abortion. During that time, not only did abortions decline, but also births for girls under 18. Apparently because of fear of disclosure, behavior actually changed. (Rogers, JL and Boruch, RF and Stoms, GB and DeMoya, D, "Impact of the Minnesota Parental Notification Law on Abortion and Birth," Am J Public Health: 8:3, pp 294-298, 1991, http://www.ajph.org/cgi/content/abstract/81/3/294 )

The confidentiality policy makes it easy to think that nobody will ever know. It is not true, of course, and even if it were, the consequences are still real. What we don’t know, or what parents don’t know, can hurt. It can hurt them, their children and all of us. I guess it amounts to a philosophical difference, do we just want to wait at the bottom of the cliff to pick up the injured, or build a fence at the top?

Ross S. Olson MD
ross{at}rossolson.org

Presented 3/3/04 at hearings of the House Health and Human Services Committee of the Minnesota Legislature regarding HF 325.

For more on Teen Confidentiality, click on Parental Notification Laws

Send comments to me at ross{at}rossolson.org

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