On confidence

A friend of mine brought this article to my attention, and I thought it was worth a comment. (For the record, Dr. Lazarus was one of my professors in residency, and I know Dr. Emans from a professional organization.) A request for confidentiality when I know the parents would prefer to know what's going on is a situation I encounter with some regularity in my practice.

In a nutshell, I agree with the author's conclusion. I try to err on the side of confidentiality whenever I can. I also do my best to wheedle, cajole and encourage the patient to talk to his or her parents when I feel it would be helpful to do so. (In case it's not obvious, like the author I always break confidentiality if the health or safety of the patient or someone else is immediately in danger.) From the standpoint of behavior modification, I try to move the patient from "precontemplation" ("My parents would never understand") to "contemplation" ("Maybe I can tell my parents"). Then, if the issue is serious enough, I'll either encourage counseling, schedule a follow-up, or both.