Delivery of confidentiality assurances to adolescents by primary care physicians

Objective: To investigate physicians' practices in assuring confidentiality to adolescent patients. Design: Mail survey. Setting: California. Participants: Seven hundred eighty-six board-certified physicians in family practice, internal medicine, obstetrics and gynecology, or pediatrics (response rate, 65%). Main Outcome Measures: Physicians were asked the percentage of adolescent patients (15 to 18 years old) with whom they discuss confidentiality during routine visits and the content of their assurances of confidentiality. A clinical vignette assessed physicians' knowledge of legal guidelines for confidential treatment of adolescents. Results: Physicians reported discussing confidentiality with 53% (on average) of their adolescent patients. Eleven percent of physicians did not discuss confidentiality with any adolescent patients. Hierarchical linear regression used to control for other physician demographic and practice factors showed that female physicians were more likely to discuss confidentiality than were male physicians (R-2 change=0.03, P<.001). There was also an association between specialty and discussing confidentiality (R-2 change=.04, P<.001); obstetricians and gynecologists were more likely to discuss confidentiality than were other primary care physicians (beta=.21, P<.001). Among physicians who discussed confidentiality, 64% assured unconditional confidentiality and 36% assured conditional confidentiality. When asked about legal guidelines for managing a 15-year-old patient with a sexually transmitted disease, 63% of physicians responded correctly, 5% responded incorrectly, and 31% were unsure of management guidelines. Conclusions: Physicians do not consistently discuss confidentiality with their adolescent patients. Most of the physicians who discuss confidentiality with adolescents assure unconditional confidentiality, which is inconsistent with professional guidelines or the legal limitations of confidentiality.