Physician Considerations When Deciding to Keep Minors' Health Records Confidential: A North Carolina Case Study

Adolescent access to confidential heath care is a well-recognized public health issue. Variation exists in state consent and confidentiality laws for minors. In North Carolina, minors can consent to certain sensitive services, but providers retain the ability to notify parents if the physician believes the notification is essential to the life or health of the minor. Thirteen qualitative interviews were conducted to compare how physicians that are specialists in adolescent health and non-specialists in North Carolina define “essential to life or health,” and thus determine protocol for releasing minors' records of confidential services to parents. Interviews, which included hypothetical scenarios, revealed that adolescent specialists were more likely to consider contextual information and less likely to make initial decisive decisions, while non-experts were more likely to make decisive decisions about disclosure, and less likely to discuss confidentiality with patients before providing care. Furthermore, most physicians were unfamiliar with details of confidentiality legislation and regulation. Recommendations include providing physicians with comprehensive information about confidentiality laws, and engaging policymakers to consider the specific and practical needs of minors that enable them to obtain care, such as proximity to clinics and availability of transportation, which can impact physician decisions to disclose. If such specific needs are addressed, minors may be more likely to obtain the care and follow up care they need, which may promote confidentiality because doctors will be assured that minors may access necessary treatment without parental intervention.