Guest columnist Julie Nielsen Lindsey, M.D., responds to NC House Bill 693, which would require notarized parental consent for teens who seek a doctor's care for testing, prevention, or treatment related to STDs, pregnancy, mental illness, and substance abuse.
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Dr. Lindsey practices family
medicine at Cary Healthcare
Associates in Cary, NC.
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As family medicine
physician who works with teenagers and as a parent of preteens, I reject
the notion that HB 693 would improve communication in families. Rather, HB 693
would undermine the helpful relationship teenagers have with their physicians
and expose teens to increased health risks and pregnancy. HB 693 will also
adversely affect physicians who work with teens and fundamentally undermine the
therapeutic relationship between teenagers and their medical providers.
As a physician to teens,
I strive to be an objective, non-judgmental, caring adult resource whom
teenagers can consult about very personal health care needs, including sexual
health and mental health. I can
assure you that neither I nor any medical colleague I know advocates teen
sexual activity, however offering confidentiality opens the door for teens to
address sexual and mental health concerns. While we encourage teens to
discuss all health matters with their parents including sexual health, we know
that sexuality is a difficult topic for teens to discuss with parents, even
supportive parents. I am most concerned with how this bill will harm teens in
troubled homes. How will HB 693 affect the girl who is raped by her father or
her mother’s boyfriend and becomes pregnant or contracts an STD? How will HB
693 affect teens who are depressed and having PTSD due to emotional abuse and
neglect by a parent with substance abuse? These are not rare exceptions. Sadly,
we see these troubling situations all too often in healthcare settings. If HB
693 passes, teenagers in both supportive homes and troubled homes will be less
likely to seek medical care for sexual and mental health care needs, and as a
result more teenagers will get pregnant, get STDs, spread STDs, have severe
pelvic infections, and there will be more suicides and untreated mental health
conditions.
In addition to
harming teenagers, HB 693 will intrude on physicians’ clinical judgment and
professional ethics. Ever since medical school, physicians have been taught to
respect teens’ confidentiality in regards to sexual health and mental health,
as these are sensitive personal issues fraught with challenges for teenagers. HB
693 would impose a fundamental change in how medicine is practiced, without a
full understanding of the harms and without endorsement of the medical
community. Such a fundamental change in medical care should originate within
the medical community after careful research on benefits and harms.
Furthermore, HB 693 will
increase legal liability and confusion for physicians who work with teens. If
HB 693 passes, I will not be able to offer my teenage patients STD testing,
prescribe birth control or conduct mental health evaluations without first
consulting a parent. If it is my clinical judgment that these are needed
services and a teen won’t discuss this with their parent, I will either incur
liability for offering the service or I will neglect my medical duty by denying
the teen the service. To add confusion, HB 693 will not apply to facilities
which receive Federal Title X funding or to patients with Medicaid. So before
addressing a teen’s concerns, a physician will need to verify what kind of
insurance a teen has, and then alter what medical services are offered. There
seems to be an element of discrimination, as some teens will be offered more
rights and services than other teens, simply based bureaucratic concerns.
Since I work in a
private practice, with mostly commercially insured patients, I will be unduly
limited in the scope of care that I can offer teenagers compared to what is
offered in a federally funded clinic or hospital system. Simply put, teenagers
would not have the right to confidential healthcare in my practice, and they
will go elsewhere. This will be a boon for facilities that receive Federal Funds. Teens are smart, and they will
preferentially seek out health care where they are afforded the confidentiality
they need.
As a family
physician, I love working with families, and I cherish the opportunities I have
to improve communication between teens and parents. I try to walk that fine
line between encouraging teens to delay the onset of sexual activity but still
educating them about sexual health, and I always encourage teens to talk with
their parents. Typically, parents choose a health care provider whom they
trust, and that doctor is an extension of the support the parent offers the
teen. There is no adversarial relationship between physicians’ and parents as
some proponents of this bill suggest. Rather physicians, parents, and teens
typically collaborate in a helpful way. HB 693 would undermine the positive
relationship that teenagers have with the family’s health care provider, and
teens will get delayed and fragmented care in settings more removed from their
family.
Lastly, I speak as a
parent of preteens. Like many parents, I too am uncomfortable by the thought of
teenagers having sex, and I am distressed by the highly sexualized and violent
content that my children get exposed to through the media and at school. While
we as parents prepare our kids the best we can and instill good values, we know
that much of our teenagers’ lives are beyond our control. We can hope and pray
that our children make good healthy choices, but as they get older we must let
go and support rather than control. Offering a teen a confidential relationship
with a healthcare provider is a loving way to extend a positive influence in
areas where our parental influence is waning. As my children get older, I will
take great comfort in leaving the exam room, knowing that my child can freely
share any health concern. It is a risky world out there, and all the more teens
need access to quality and confidential health care to support them through
this challenging time of life and manage the risks. Please, let’s not make life
any more difficult for teenagers or for the doctors who serve them. House Bill
693 fundamentally undermines healthcare for teens in North Carolina.
