As a pediatrician, part of my job is to freely discuss potentially risky behaviors with patients and their families. Providing this advice is often calledanticipatory guidance.
If I see a consistent issue or concern among my patient families... It becomes an issue to anticipate. So, I talk about it.
The anticipatory topics for teens range from healthy eating choices and exercise habits, to protection from drunk driving and sexual abuse. The topics I choose to discuss with each teen are based upon what I know of my patient, her family, and her peers in our community.
For me, anticipatory guidance is more than just something recommended by the AAP that I am “required” to do. I strive to make health care visits with my families meaningful, to promote healthy life-long habits, and to prevent themost common causes of deathin teens. My goal is to start a family discussion that can be continued during the car ride home and around the dinner table. I want to spark topics of conversation, so parents can share their values and expectations.
Today, one of the concerning issues in my community is the effect of uncontrolled mobile phone use. Phones are causinghazardous driving situations, interrupted sleep,andrisky exposure. Appropriatecell phone use, therefore, is a topic I often discuss.
One clinic afternoon, after having a pleasant conversation with a teen and her mother, I hadsome time alone with my patient. I asked my usual opening question, “This is a time for you. What do you want to talk about today?”
My patient, a beautiful teen girl with bright eyes and dark fingernails, said,
“I do have something I want to talk to you about. You just told my mom that she can read my text messages. I really didn’t like that. That is a violation of my right to privacy, and it is none of your business.”
I would be lying if I said that I wasn’t taken aback. Although it was not the first time an adolescent was unhappy with me, at that moment in time I was not expecting her candid concern.
I told her that I stood by my recommendations. As a minor, she has the right to shelter, food, and basic education. She also has fundamental natural rights, and presumed first amendment rights.
But right to privacy? Generally speaking... No.
In my opinion, teens having “privacy,” or respected personal boundaries, is based on trust. Having limitations and monitoring on all tech devices allows her to to make decisions in a more controlled manner; while showing discipline and respect to others. Routinely showing appropriate digital use earns trust.Privacy can then be rewarded. Until then, her mother, as purchaser of both the cell phone and phone plan agreement; has the right to view, review, and revoke her property (the cell phone) at any time.
As for the second part of her concern,
doing what I can to protect my patients is my business; in fact, it is my job.
I continued to explain that as her doctor, if there are things in her life that could lead to her harm; I want to be a sounding board of warning for her parents. That is the foundation of anticipatory guidance. If I can anticipate problems and pitfalls, her parents can have the opportunity to limit potential harm. My job is to encourage and empower families with information to keep their kids healthy. Her success and safety are my priorities.
A way that I can promote her welfare, and the welfare of all teens, is to extend my judgement of what will allow patients to thrive. As a physician and a parent, I have the privilege of observing hundreds of families, their choices, and the consequences. I choose to share what I believe promotes successful families. Sharing these observations comes with risk, as my values may not coincide with the values of my patient families. However, I think there is a greater risk of a child making a harmful decision if I don’t speak up.
I thanked my patient for talking honestly with me; she taught me a valuable lesson. I will continue to stand by my cell phone rules, and I will continue to anticipate parental challenges and discuss them with my families. But, as a result of her concern, I will explain my intent and motivation more clearly to my patients:
To stimulate a discussion on safe choices and expectations of behavior that can to be continued in a more valued place, her home.
What do you think? Is anticipatory guidance an important part of your child’s health care visits? Or, do you think health care providers are stepping over an inappropriate line by offering advice about sensitive topics?