Rashes and Fever

Practical Barriers to Adolescent Confidentiality: Can They Be Overcome?

August 24, 2009

I read with interest Drs Someshwar and Nield’s Parent Coach feature, “Adolescent Confidentiality: Where Are the Boundaries?” (CONSULTANT FOR PEDIATRICIANS, May 2009, page 182). The authors state that the adolescent daughter of the mother who was making inquiries “was given a prescription for a hormonal contraceptive.” The cost of birth control pills (eg, $25/month for a generic tricyclic, sometimes used for acne—or $35/month for drospirenone and ethinyl estradiol() would make it impossible for most 15-year-old girls not to disclose their sexual activity to a parent or guardian. In addition, some third-party payers (ie, insurance companies) require a paper trail to be generated, which could also “blow” a secretive teen’s “cover.”

— Peter D. Magnus, MD, MPH
    Bend, Ore

We appreciate your taking the time to share your thoughts about adolescents and confidentiality. Your comment emphasizes the need to warn adolescents that even though we may keep certain issues confidential, insurance companies and other third parties may not. In some instances, we’ve worked around this problem by providing free contraceptive samples on a limited basis and not charging for pregnancy tests. However, this obviously is not feasible in all instances.

Some working teens have paid for contraception themselves, but we’ve also seen many others who bought cigarettes with the money they earned. It’s unfortunate that we aren’t able to write a prescription for responsible behavior!

— Jean Someshwar, MD
Assistant Professor of Pediatrics

— Linda S. Nield, MD
Associate Professor of Pediatrics
West Virginia University School of Medicine