What to do with what kids tell you...

[Happiness]

Good topic. I work in very close knit community and I have come across this in the back of the ambulance. If I suspect that a girl is pregnant (because iv been called for a fainting). When it comes time to ask the question "Is there a chance you may be pregnant" I get close to my pts ear and whisper it to her or I will wait to be in the back of the car. If she says this maybe a possibility I encourage her to tell her parents. I will not tell the parents as it is better coming from the child. I was 18 when I had to tell my parents and no matter how hard it was to tell them it was better than someone else telling them. The other thing you have to contend with this particular subject is that there are times that you go into a home and everything appears to be nice and cozy but as we all know it isn't always that way. Children that are in abusive homes are less likely to open up and if you are lucky to get them to do it with you, don't break that trust because it will never come back.

I have also been told other things in confidence by teens and I have always encouraged them to tell there parents what is going on. Many times I have had the parents come to me and ask why I didn't say anything and the reply from me is "Who do you want to hear it from me or your kid" and the answer back is the child. Having a childs trust is a very important thing to me. In my position in the community the kids know me and my family and they know they can come and talk to me anytime, and all kids really need is someone that is bias that will help them through whatever is going on.

When it comes to going to the Drs. I make my kids do their own appointments (3 boys and they started at 12) and they know I will go if they want me to. I have gone to everyone of my boys appointments with their permission. I feel that parents should let the kids make the appointments as it teaches them how to do it, that they can go without mom or dad and that they can have a confidential appointment with their drs. Drs need to be able to have a relationship with the kids that they see and I personally think that unless a child is in immediate danger that confidentiality should pervail.

I personally haven't had a kid say anything to me yet that would make me feel that I have to go to the parents about and I hope that I never have to have that experience because I really don't know if it would be the parents I would go to. The one thing I make sure is that if a child is apprehensive about talking it is the Dr that I have gone to in the past.

Crotchity I don't know what part of Canada your from but I have never heard of a parent going and getting a copy of my report. I don't know if they even can in BC. I think that the original post was if you as the attending Dr or emt do you break confidentiality on things other than imediate danger to parents not whether you document it. If you have good reporting skills you document everything that is said to you in your assesment.

[crotchitymedic1986]

I wasnt speaking about canada, i was speaking about the US. In the US the parent can access and get copies of their minor-child's medical records, including EMS trip reports. So if you keep information confidential, as you have stated, but document the secret in your run report, the parents can easily access the secret.

[Eydawn]

I don't know of many parents who are competent enough in the medical system to even realize that we document things just like a hospital does... and what you document in your trip sheet and what you choose to verbally relay to a parent can easily be two different things. Your trip sheet is your legal documentation of care provided, assessments, and information pertinent to the provision of care to the patient. Sure, a parent COULD potentially access it... but how many realistically will?

For example... how many of us have documented that we suspect a child's injuries are the result of child abuse in the trip sheet, but not said a word to the parents and simply reported it to CPS?

Just as this article indicates, this is a GREY ZONE. Keeping something confidential in terms of your direct interaction with parents and putting something in your documentation because you are legally required to is not contradictory, or breaching confidence with your patient. Things that are directly affecting a child's well being and safety need to be brought up. But it doesn't mean one has to immediately run to parents with everything one finds; there is plenty of room for advising a teenager or tweener to approach their parents first and have it come from them. Especially in the case of pregnancy... and it's not like the parents not knowing for 10 more minutes while you counsel the lass and tell her that there's no real way to keep it secret is going to kill them.

As far as the emancipation thing.... I was under the impression that any choices about prenatal care and the care of the underage mother's child was her right and her decision, but that her legal status remained as a minor and a ward of her own parents until she legally became emancipated or reached age of majority. AKA: Prego teen can say "yes, I want to have this ultrasound done and test for genetic problems with this pregnancy" even though her mother says no way, don't test. Prego teen cannot refuse treatment for chest pain if her mother says yes, treat my daughter for this.

Perhaps I am confused, or maybe it's a local thing... time for me to go look it up again.

Wendy

CO EMT-B

[crotchitymedic1986]

well stated wendy, and i imagine the laws very state to state, just as there are different rules for minors who want an abortion in various states.

But lets say you have a 12 year old that crashes his bike on the way to the store,or injures himself on the playground at school. He is not seriously injured, just skinned up. Either as a result of your questioning or because he just wants to tell you, he admits that he is using crack cocaine on a regular basis. Parents arrive, sign the refusal, and are putting him in the car for the ride home. Do you have an obligation to tell the parents what you know ? He is not in a lifethreatening situation at the moment, but obviously if he continues to smoke crack, he will not live a long life. If you do not have a responsibility as a medic, dont you have a responsibility as an adult.

If the kid said he was going to carry a BBgun to school tomorrow, not to shoot anyone, but just to scare a bully ? Wouldnt you tell someone ?

[Eydawn]

Bogus, both hypotheticals. If I have a kid who tells me that he's using crack, I'm suspecting more than a skinned knee from the fall and I'm suspecting the cause of the fall itself. He goes to the ER for a full workup, and it becomes the doctor's responsibility to inform the parents that the kid is abusing an illegal substance. I'm probably going to tell them as well... but it makes a difference if it comes from a doctor.

Kid says he's going to take a BB gun to school to "scare" someone, I'm telling the cops, because I could very well tell the parents, have them brush it off, and then have the poor kid end up in jail due to hyper-reactive school officials. If I tell the cops, the cops tell the parents, and it's legally documented. Plus kids are much more likely to listen to a stern talking to from the cop... and the cops can deal with the bully situation if this kid is facing continual harassment. I can't do anything about some asshat beating this kid up every day. But a police officer can.

Yes, there are instances in which I'm going to tell parents what children have told me. But it is a difficult line to tread. What I'm saying is that discretion and intelligent thinking are your best bet- not assuming that you have to tell parents absolutely everything that their child tells you. I think that's what the doctor in the original article seemed to think as well.

Wendy

CO EMT-B

[fiznat]

As far as the emancipation thing.... I was under the impression that any choices about prenatal care and the care of the underage mother's child was her right and her decision, but that her legal status remained as a minor and a ward of her own parents until she legally became emancipated or reached age of majority.

Crotchity is right, these laws vary state to state. The way you said it is how it is here as well, but I know that isn't that way everywhere.

That is a good scenario about the crack cocaine. I think our role differs quite a bit from that of the doctor who wrote the article. True we want to foster trust with our patients, but it isn't like we establish personal relationships over the course of years like a family doctor might. On balance, I don't think I would hide something like crack use in a 13 year old from the parents. That's pretty hardcore. If it was something a little less dangerous (like maybe the patient confided in me that he scraped his knee after throwing rocks at cars), I might keep the details private but relay a more general comment to the parents. I'd guess that this is a more case by case basis, since we're cutting out the extremes (abuse, etc) and looking only at the gray areas.

[mshow00]

This is just like everything else in the field, benefit vs risk. What will happen (either potentially or actually) vs the possibility of loosing that persons' trust for the next time. I mean if you get a call for an accidental injury at a school the child at some point confesses to you that his injuries are a result of a couple of bullies. Now option1 is say something to school/parents etc. they "get involved" and the next week you get called for an assault the same pt, only now he has a sever TBI due to the retaliation for "tattling". Option 2 you don't say anything and your pt brings a gun to school and "fixes his own problems". Option 3 again you report it up the proper chain, only to have this kid withhold pertinate information the next time to pick him up. I know this is an extreme example, but the concept is the important part, risk vs benefit.