Image by Katja Schulz from Washington, D. C., USA (Lycid Caught in Spider Web) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
Recently the topic of the required printed After Visit Summary (AVS) for pediatric and adolescent gynecology patients came up on a nurse discussion site. In many states, children 12 years old and above can come to the clinic without a parent, and they alone can choose who can access their health information with respect to substance abuse, birth control, abortion, and sexually transmitted diseases. Because the bill is usually paid by the parents one way or another, the parents may learn about the clinic visit indirectly anyway – a topic of another discussion (sometimes the codes on the insurance statements are vague, and sometimes not).
The main discussion revolved around how nurses can meet the requirements to provide a written summary without increasing the chances that parents will learn the actual diagnosis and treatment of their child. Various contributors discussed the legality and logistics of providing children whose parents bring them to the clinic or otherwise are aware of the visit with a discharge summary that simply omits all tests and procedures involving birth control, abortion, and sexually transmitted diseases.
My response:
Oh the tangled webs we weave!
So, the legislature has decided, apparently at the medical community's behest, that parents are fully responsible for paying for the medical care of their children, but they are not accountable for it. In fact, "ideally", parents are not even supposed to know if their child has a health condition that led them to seek medical intervention. The sole legitimate role of the parents has been reduced to money: they are required to pay (the medical bills, and to clothe, house, and educate their children). If parents somehow feel that this responsibility logically accompanies any authority, or input, or even information, they are quickly informed that they have no seat at the table - they must simply beg their child to inform them after the decisions have been made and the bills have been paid. This is considered the "respectful" way to handle the problem of adolescent sex.
Has it occurred to anyone that this feeds into the problem highlighted by the #MeToo movement? Not every teen sexual encounter is voluntary and uncoerced. Parents (mothers, in particular) are often a child's best ally when a teacher, uncle, neighbor, or older friend is applying pressure to do something that is not in the best interest of the child. Parents often can and will play the role of the "villain" by limiting contact with a sexual aggressor when a child gets in over their head and needs to save face.
But no, the privacy laws assume that all children who have sex do so because it is their desire to do so. We “good” nurses will be “supportive” of the child’s right to engage in a destructive lifestyle – or to be bullied or victimized – because we are so “enlightened.” This may make us feel better, but it does not help the children who are being abused. Studies show that most women (let alone teens) who have abortions do not chose this option for themselves: they are pressured into it. (Link to study in this article https://www.pop.org/many-american-women-felt-pressured-abortions-study-finds/).
#MeToo revealed that most teen sex is not truly consensual.
Have we learned nothing?