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Student's Guide

Case summary

A 14-year-old accompanied by her mother presents with complaints of nausea and vomiting for two weeks. After her mother leaves the room, she admits to being sexually active, and tells you that she has had unprotected intercourse recently with her boyfriend and missed a period. Her parents do not know she is sexually active, and she does not want her mother to know that a pregnancy test is being done or the result of that test. Pregnancy test comes back positive.

  • Do you disclose the test results to the patient’s mother?
  • Do you disclose the test results to the patient first?
  • How will you get the mother to leave the room to disclose results?
  • What if the mother asks about test results?

Learning objectives

  1. Discuss the basis of the duty of medical confidentiality and its application to the adolescent patient.
  2. Identify situations in which breaking confidentiality is justified and the conditions that must be met to break confidentiality.
  3. Recognize the physician’s duty to the patient when confidentiality is violated.
  4. Identify threats to the patient’s confidentiality that you may not be able to control.
  5. Discuss whether deception is justified to maintain confidentiality and any alternatives to the use of deception.

Suggested reading for students

American Medical Association Council on Judicial Affairs. Confidential health services for adolescents. JAMA. 1993;269:1420-1424.

Bok S. Secrets: On the ethics of concealment and revelation. New York: Random House, Vintage Books; 1984.

Booth M, Bernard D, Quine S, et al. Access to health care among Australian adolescents: young people’s perspectives and their socio-demographic distribution. J Adolesc Health. 2004;34:97-103.

Burnum JF. Secrets about patients. New Engl J Med. 1991;324:1130-1133.

Cheng TL, Savageau JA, Sattler AL, DeWitt TG. Confidentiality in health care: a survey of knowledge, perceptions, and attitudes among high school students. JAMA. 1993;269:1404-1407.

Ford C, Millstein S, Halpern-Feisher B, Irwin C, et al. Influence of physician confidentiality assurances on adolescents’ willingness to disclose information and seek future health care. a randomized controlled trial. JAMA. 1997;278:1029-1034.

Geiderman JM, Moskop JC, Derse AR. Privacy and Confidentiality in Emergency Medicine: Obligations and Challenges. Emerg Med Clin N Am. 2006;24:633-656.

Klein J, Wilson K, McNulty M, et al. Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls. J Adolesc Health. 1999;25:120-130.

McPherson A, Macfarlane A, Allen J. What do young people want from their GP. Br J Gen Pract. 1996;46:627.

Reddy D, Fleming R, Swain C. Effect of mandatory parental notification on adolescent girls’ use of sexual health care services. JAMA. 2002;288:710-714.

Siegler M. Confidentiality in medicine — a decrepit concept. New Engl J Med. 1982;307:1518-1521.

Thrall J, McClosky L, Ettner S, et al. Confidentiality and adolescents’ use of providers for health information and for pelvic examinations. Arch Pediatr Adolesc Med. 2000;154:885-892.

Weiss BD. Confidentiality expectations of patients, physicians, and medical students. JAMA. 1982;247:2695-2697.

This student’s guide was developed by Douglas S. Diekema, MD, MPH, director of education, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital.

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