Not long ago, I treated a 14-year-old female patient with a history of vaginal discharge, and the patient's mother insisted on being in the room for the entire visit. Somewhat predictably, when I asked the patient about her sexual history, she denied any sexual activities. A urine cytology later was positive for gonorrhea.

Perhaps my patient would have been more forthcoming had her parent not been in the room. The American Academy of Pediatrics recommends clinicians talk with patients one-on-one starting at age 11.^1,2 But a 2016 report found that only about 38% of patients age 15–17 spent time alone with their physician in the previous year.³ Lack of privacy and confidentiality makes it more difficult to discuss sensitive personal issues, such as mental health or sexual health, and poses a significant barrier to comprehensive care for adolescent patients.

Confidential adolescent care requires cooperation at three levels.