I’m a pediatrician in Michigan, so I was a bit surprised by a blog post swirling on Facebook regarding a “new law” in Michigan requiring children to have a private five minute conversation with a nurse. I read the post, and sure enough, this Michigan office posted a concerning sign claiming a new law required children to have a nurse visit without a parent. Obviously, I take care of kids all day long and hadn’t heard of such a law, so I was as alarmed as this mom.
But to be honest, my first response was less alarm about parental rights as it was, “please God not another mandate”. I was trying to visualize setting up a private room, finding a way for my nurses to spend five minutes with all these kids once a year at their visits, sometimes when they’re sick, documenting the encounter, tracking down the kids in December that we hadn’t documented on yet that year, getting the mandated information to them. All for free. That’s the sad state of healthcare right now: another day, another mandate.
The follow-up to the story, is that this Michigan mom confronted the office and they removed the sign, admitting there is thankfully no law mandating such a conversation between child and nurse.
This online portal is now available to 12 – 17 year olds; they can sign up for their own account. Because of current law, these minors have the option of denying their parents access to the on-line account. This information would be included in the private conversation mentioned on the sign.
The five minute conversation would also inform the minor that he can receive reproductive care without parental consult or consent. This would include information on STDs, HIV and birth control. This is also a result of legislation – but this has been on the books for years.The ability of the minor to deny his parents access to the on-line portion of his medical records is required by law. The ability of a medical professional to offer reproductive care without parental consent is required by law.
What is not required is the five minute private conversation between a minor and a nurse.
But now my second response is one of sadness and dismay that we’ve come to this point in healthcare, where patients and parents justifiably question our commitment to individualized and confidential care. Indeed all the comments and conversation on this issue lump the doctor and government together, assuming we work in concert with a free flow of information.
This lack of trust on who your doctor actually works for is virulent and toxic. I’ve had recent cases of parents refusing the newborn metabolic screen in the hospital, citing concern that blood samples are sent to the state. These tests screen for conditions that cause irreversible brain damage if left untreated, yet the fear of government causes parents to make decisions that could adversely affect health. I’ve had teenagers and parents refuse to discuss issues honestly with me because of the computerized health records and concerns about privacy and security. It breaks my heart, but these are valid concerns by patients and parents.
So how do we fix some of this? First off, it is essential to have a personal physician you trust and who respects your privacy and your moral beliefs. As kids get older, it’s better medicine to allow privacy during the physical exam. Having a trusting relationship with your doctor is what allows this natural progression to take place. It allows time for the child to ask questions they may feel uncomfortable asking in front of a parent. It allows the patient a forum to bring up depression, anxiety, suicide, weight, abuse, bullying, sex, drugs and alcohol. In general, I don’t get a lot of shocking revelations. When I do, I try my best to encourage the child to discuss the issue with their parent. I’ve even had kids ask me to stay in the room while they tell their parents what’s going on.
Secondly, it’s really important to develop open communication between parent and child. I love it when a parent has prepped their child to know they will have time to raise any private concerns with me. This team approach is beyond awesome. The kids are not nearly as awkward during the visit, they come prepared with something to ask, the parental “OK” allows the child to speak honestly and nearly every time….the child voluntarily tells the parent what we discussed when the parent comes back in the room.
As far as the blurred lines between doctor and government, your private health and the public good, that’s a bigger battle and one that requires rebellious doctors & their patients to fight together for patient privacy and individualized care. I applaud this Michigan mom for joining with her doctor’s office in the battle, one small win in the encroaching bureaucracy that tries to blur these lines and drive a wedge between patient and doctor, parent and child.
Meg Edison MD is a pediatrician in private practice. You can follow Dr. Edison on Twitter @megedison