By Ellen Friedrichs
Sometime, towards the beginning of high school, I began going to the doctor alone. Not always, of course. My mom sat in the waiting room for plenty of appointments, and my dad spent hours with me in the ER for things like my broken arm, or for stitches after a fall.
But my parents were also busy with jobs and kids, and they encouraged my independence. Plus, growing up in Vancouver, Canada, at a time when universal health care was a given, public transportation was available, and the city run teen clinic offered a range of confidential services, meant that I actually was able to begin to take responsibility for some of my medical needs at a pretty early age.
That didn’t mean I never involved my parents in sensitive matters. In a bid to get them to let me sleep over at my boyfriend’s house, I told them I was already on the pill. The conversation was as awkward as one might imagine. But the fact that I had taken this step by myself, did actually help make my case.
And whatever you think about teens becoming sexually active (which, for the record in the context of a healthy relationship between older teens is generally considered developmentally appropriate and not an automatic red flag for danger) the fact of the matter is, learning how to take care of the full health spectrum of one’s health is a crucial life skill, and for adolescents, an important part of practicing for adulthood.
Certainly, many leading medical bodies encourage teens to become independently involved in their health care, and everyone from the American Academy of Family Physicians, to the Society for Adolescent Medicine to the American College of Obstetricians and Gynecologists stresses the importance of providing teens confidentiality surrounding their care. That’s because decades of research have found that when teens know that they can expect confidentiality, they are more likely to go to the doctor, they are more likely to get follow-up care, and they are more likely to share information with doctors about things like sexual activity, substance use, and their mental health.
Unfortunately, accessing such care simply isn’t possible for a lot of American youth. For one thing, there are some providers who simply aren’t comfortable with a kid turning up alone. I literally had to switch my daughter’s orthodontist when an office policy changed to require that a parent attend every visit. That was logistically difficult for my family and just seemed unnecessary. In that case, finding a dentist with a more relaxed rule was possible. But often, situations are a lot more complicated, and a lot more sensitive.
Geography, finances and politics play a huge role in determining access to services. A huge number of American minors continue to be uninsured or underinsured. Many simply can’t obtain even the most basic health care, let alone that of an intimate nature. And those who want privacy for things like abortions, gender-affirming care, or even vaccinations are often out of luck, since, if such care is even available, teens increasingly need their parent’s permission to access it.
But even when minors legally have the right to confidentiality, as they do in a lot of states for things like birth control, or mental health care, or substance use treatment, this can be breached in all sorts of ways. Medical staff may be unaware of the laws. Or they may accidentally (or intentionally) inform parents about a procedure, treatment, or even a teen’s inquiries. Adolescents can also receive what appears to be confidential care, yet the second an insurance statement arrives, or an office calls home to confirm an appointment, or a parent looks at a patient portal, that confidentiality means nothing.
Additionally, our current system just isn’t set up to teach young people how to navigate their healthcare alone. Hell, I’m in my 40s and the bizarre patchwork of rules and regulations that results in things like providers who may be in-network one day and out the next, or procedures that may need pre-approval if you haven’t met your deductible, but don’t if you have, can be overwhelming. So I wasn’t surprised when I recently asked my 11th grade health class how many of them thought they could figure out how to go to the doctor alone and only a handful said yes. The barriers they mentioned were things like not having their insurance cards or money for co-pays, not knowing how to find a specialist, and, if they did want privacy, having no idea how they would account for the hours needed to undertake an appointment.
Ultimately, it would be great if teens involved their parents in their healthcare, and many do. But the reality is, there will always be young people who simply can’t or simply won’t. And while it might seem counterintuitive, giving kids some privacy—even if it is just in the form of sitting in the waiting room while they go into an appointment—will lead to improvements in their mental and physical health. It may also have another benefit. Skilled providers can help encourage youth to talk to their parents, and when teens get that kind of support and when they see that they are trusted, they are more likely to trust you back.
Ellen Friedrichs is a contributing writer for Motherwell. She is a health educator and mom of three based in New York. Find her at sexEdvice.com.
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