DELIVERY OF CONFIDENTIALITY ASSURANCES TO ADOLESCENTS BY PRIMARY-CAREPHYSICIANS

Objective: To investigate physicians' practices in assuring confidenti ality 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 ped iatrics (response rate, 65%). Main Outcome Measures: Physicians were a sked the percentage of adolescent patients (15 to 18 years old) with w hom 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 o f 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 patien ts. Hierarchical linear regression used to control for other physician demographic and practice factors showed that female physicians were m ore likely to discuss confidentiality than were male physicians (R-2 c hange=0.03, P<.001). There was also an association between specialty a nd discussing confidentiality (R-2 change=.04, P<.001); obstetricians and gynecologists were more likely to discuss confidentiality than wer e other primary care physicians (beta=.21, P<.001). Among physicians w ho discussed confidentiality, 64% assured unconditional confidentialit y and 36% assured conditional confidentiality. When asked about legal guidelines for managing a 15-year-old patient with a sexually transmit ted disease, 63% of physicians responded correctly, 5% responded incor rectly, and 31% were unsure of management guidelines. Conclusions: Phy sicians do not consistently discuss confidentiality with their adolesc ent patients. Most of the physicians who discuss confidentiality with adolescents assure unconditional confidentiality, which is inconsisten t with professional guidelines or the legal limitations of confidentia lity.