What to Do When the Patient Says, 'Please Don't Tell Mom'
Some years ago, in the candor (坦白) of the exam room, a sh-grade boy told me that he didn't really have friends at school, and that he sometimes found himself being picked on．I gave' him the pediatric (儿科的) line on bullying: it shouldn't be tolerated, and there are things schools can do about it．Let's talk to your parents, let's have your parents talk to the school．And he was horrified．He shook his head and asked me please not to interfere, and above all not to say a word to his mother, who was out in the waiting room because I had asked her to give us some privacy.
He wouldn't have told me this at all, he said, except he thought our conversation was private．The situation at school wasn't all that bad; he could handle it．He wasn't in any er, wasn't getting hurt, and he was just a little lonely．His parents, he said, thought that he was fine, that he had lots of friends, and he wanted to keep it that way.
When treating older adolescents, pediatricians(小儿科医师)routinely offer confidentiality (机密性) on many issues, starting with and substances．But middle-schoolers are on the border--old enough to be asked some of the same questions, but young enough that it can be less clear what should stay confidential.
At my own eighth-grade son's pediatric checkup last year, I of course left the room, because I didn't want to embarrass him or inhibit him, and because I wanted his pediatrician to have the opportunity to hear anything he wanted to say．(I am reporting this with my son's explicit permission.) But as I waited, I thought of that sh grader, and of the other middle-schoolers who have told me things that left me agonizing about the ethics and the wisdom of confidentiality in this age group.
I'm not talking about the child who tells you something that makes it clear he's in er．Those are the 'easy' ones (though in another sense they can be tremendously difficult), and I've had my share: The 13-year-old girl who is frightened of a much older guy who sometimes seems to follow her home．The 14-year-old boy who has been thinking about dying a lot ever since his grandmother died．The sh grader who is being beaten up on the playground．No matter the age, when I feel the child is actually in er, I explain that I have to let the parents know．But as I talked to my colleagues--including my son's pediatrician, Dr．Herbert Lazarus- we all kept coming up with ambiguous cases．Because you do value the child's trust and you don't want to lose it.
I'm not talking about the child who tells you he shared a beer with his friends one day after school．Most sensible parents, I think, know that once they're out of the exam room we're going to review , drugs and rock 'n' roll with their children, and most sensible parents, I think, are grateful．And many middle-school children seem grateful for the opportunity to mention that they have been in situations where people are drinking.
'They'll preface it with ' My mom's not going to know about this, right?'' said Dr．Lazarus, who is also a clinical associate professor of pediatrics at New York University．'I'm going to talk as much as I can about why this is not good, and all we know about alcohol and marijuana．There are enough studies out there that show how bad this is for brain development.'
But what about if it's more than a beer? One of my colleagues had a stow: a 13-year-old girl who was drinking and stealing from her parents' liquor cabinet．'She did admit that to me,' the pediatrician said．'She was doing it by herself, not a good sign, not social drinking.' The child did not want her mother to know, and the pediatrician, who had known her since infancy, negotiated (协商) a compromise: the doctor would advise the mother that the girl needed counseling, and as long as she went to counseling, a

What to Do When the Patient Says, 'Please Don't Tell Mom'
Some years ago, in the candor (坦白) of the exam room, a sh-grade boy told me that he didn't really have friends at school, and that he sometimes found himself being picked on. I gave' him the pediatric (儿科的) line on bullying: it shouldn't be tolerated, and there are things schools can do about it. Let's talk to your parents, let's have your parents talk to the school. And he was horrified. He shook his head and asked me please not to interfere, and above all not to say a word to his mother, who was out in the waiting room because I had asked her to give us some privacy.
He wouldn't have told me this at all, he said, except he thought our conversation was private. The situation at school wasn't all that bad; he could handle it. He wasn't in any er, wasn't getting hurt, and he was just a little lonely. His parents, he said, thought that he was fine, that he had lots of friends, and he wanted to keep it that way.
When treating older adolescents, pediatricians(小儿科医师)routinely offer confidentiality (机密性) on many issues, starting with and substances. But middle-schoolers are on the border--old enough to be asked some of the same questions, but young enough that it can be less clear what should stay confidential.
At my own eighth-grade son's pediatric checkup last year, I of course left the room, because I didn't want to embarrass him or inhibit him, and because I wanted his pediatrician to have the opportunity to hear anything he wanted to say. (I am reporting this with my son's explicit permission.) But as I waited, I thought of that sh grader, and of the other middle-schoolers who have told me things that left me agonizing about the ethics and the wisdom of confidentiality in this age group.
I'm not talking about the child who tells you something that makes it clear he's in er. Those are the 'easy' ones (though in another sense they can be tremendously difficult), and I've had my share: The 13-year-old girl who is frightened of a much older guy who sometimes seems to follow her home. The 14-year-old boy who has been thinking about dying a lot ever since his grandmother died. The sh grader who is being beaten up on the playground. No matter the age, when I feel the child is actually in er, I explain that I have to let the parents know. But as I talked to my colleagues--including my son's pediatrician, Dr. Herbert Lazarus- we all kept coming up with ambiguous cases. Because you do value the child's trust and you don't want to lose it.
I'm not talking about the child who tells you he shared a beer with his friends one day after school. Most sensible parents, I think, know that once they're out of the exam room we're going to review , drugs and rock 'n' roll with their children, and most sensible parents, I think, are grateful. And many middle-school children seem grateful for the opportunity to mention that they have been in situations where people are drinking.
'They'll preface it with ' My mom's not going to know about this, right?'' said Dr. Lazarus, who is also a clinical associate professor of pediatrics at New York University. 'I'm going to talk as much as I can about why this is not good, and all we know about alcohol and marijuana. There are enough studies out there that show how bad this is for brain development.'
But what about if it's more than a beer? One of my colleagues had a stow: a 13-year-old girl who was drinking and stealing from her parents' liquor cabinet. 'She did admit that to me,' the pediatrician said. 'She was doing it by herself, not a good sign, not social drinking.' The child did not want her mother to know, and the pediatrician, who had known her since infancy, negotiated (协商) a compromise: the doctor would advise the mother that the girl needed counseling, and as long as she went to counseling, a