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'Parents are not my patients' 'Parents are not my patients'
(about 3 hours later)
VIEWPOINT Dr Ann McPherson GP and teenage health expertVIEWPOINT Dr Ann McPherson GP and teenage health expert
Teenagers feel pressure to have sexTeenagers feel pressure to have sex
There has been much debate over whether GPs should prescribe contraception to under-16s without telling their parents.There has been much debate over whether GPs should prescribe contraception to under-16s without telling their parents.
In this week's Scrubbing Up health column, Dr Ann McPherson says doctors have a duty to the patient - not the parent - but that it is not a black and white situation.In this week's Scrubbing Up health column, Dr Ann McPherson says doctors have a duty to the patient - not the parent - but that it is not a black and white situation.
A 14-year-old girl has come to me seeking contraceptive advice.A 14-year-old girl has come to me seeking contraceptive advice.
But her concerns are not about her healthcare. They're about her privacy.But her concerns are not about her healthcare. They're about her privacy.
"If my mum finds out she'll kill me.""If my mum finds out she'll kill me."
It's the kind of dilemma that health professionals are often faced with.It's the kind of dilemma that health professionals are often faced with.
The General Medical Council (GMC), the body that regulates doctors, says children and young people are "individuals with rights that should be respected". It can sometimes very difficult and uncomfortable to deliver such a serviceThe General Medical Council (GMC), the body that regulates doctors, says children and young people are "individuals with rights that should be respected". It can sometimes very difficult and uncomfortable to deliver such a service
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This means we have to listen to them and take into account what they have to say. It also means respecting their decisions and confidentiality.This means we have to listen to them and take into account what they have to say. It also means respecting their decisions and confidentiality.
The GMC also says a young person under 16 may have the capacity to consent, depending on their maturity and ability to understand what is involved.The GMC also says a young person under 16 may have the capacity to consent, depending on their maturity and ability to understand what is involved.
At risk?At risk?
Contraceptives, abortion and sexual transmitted infection advice and treatment can therefore be provided to young people under the age of 16, without parents knowing, so long as the young person fully understands the medical advice and its implications.Contraceptives, abortion and sexual transmitted infection advice and treatment can therefore be provided to young people under the age of 16, without parents knowing, so long as the young person fully understands the medical advice and its implications.
But the key dilemma for a GP is how to judge the competence of someone under 16 to do that.But the key dilemma for a GP is how to judge the competence of someone under 16 to do that.
In truth, many people over that age do not fully understand, in the GMC's words, "all aspects of the advice and its implications" when given by a doctor.In truth, many people over that age do not fully understand, in the GMC's words, "all aspects of the advice and its implications" when given by a doctor.
One solution is for us to explain the situation to the teenager and then ask them to sum up, in their own language, what they have understood.One solution is for us to explain the situation to the teenager and then ask them to sum up, in their own language, what they have understood.
This is less than perfect.This is less than perfect.
But then, what do we do if we think the young person will continue to put themselves at risk by having sex when they do not fully understand all the implications and won't talk to their parents?But then, what do we do if we think the young person will continue to put themselves at risk by having sex when they do not fully understand all the implications and won't talk to their parents?
Sex 'everywhere'Sex 'everywhere'
The GMC recognises that it is an imperfect world and says in these circumstances, to go ahead with advice and treatment.The GMC recognises that it is an imperfect world and says in these circumstances, to go ahead with advice and treatment.
After all, better that teenagers use contraception than get pregnant.After all, better that teenagers use contraception than get pregnant.
Recent reports of the abstinence movement in the USA shows that does not work.Recent reports of the abstinence movement in the USA shows that does not work.
Keep the lines of communication openKeep the lines of communication open
In fact, many of the girls who sign up to it are more likely to have sex without using contraception.In fact, many of the girls who sign up to it are more likely to have sex without using contraception.
But why are we seeing adolescents who appear to be "overly sexualised" at an early age?But why are we seeing adolescents who appear to be "overly sexualised" at an early age?
Often one wonders if it would be better if only young people didn't see sex everywhere in the media.Often one wonders if it would be better if only young people didn't see sex everywhere in the media.
What evidence there is does indicate that the greater the sexual exposure to sexual content in the media, the more permissive attitudes towards sexual activity, the higher the incidence of sexual experience and the more and the earlier sexual behaviour occurs.What evidence there is does indicate that the greater the sexual exposure to sexual content in the media, the more permissive attitudes towards sexual activity, the higher the incidence of sexual experience and the more and the earlier sexual behaviour occurs.
This research shows that adolescents seem to accept, learn from and emulate behaviours seen in or on the media as being normal, attractive and without risk.This research shows that adolescents seem to accept, learn from and emulate behaviours seen in or on the media as being normal, attractive and without risk.
AmbitionAmbition
Even for those of us dealing with these problems, who know that a confidential medical service is essential to ensure that young people use the service, it can sometimes very difficult and uncomfortable to deliver such a service.Even for those of us dealing with these problems, who know that a confidential medical service is essential to ensure that young people use the service, it can sometimes very difficult and uncomfortable to deliver such a service.
More and better age-appropriate sex and relationship education, good role models - and better parental input will all help.More and better age-appropriate sex and relationship education, good role models - and better parental input will all help.
When it comes to teenagers not getting pregnant, as the saying goes, "ambition is the best contraception" - whether this is ambition in the teenagers themselves or of the parents.When it comes to teenagers not getting pregnant, as the saying goes, "ambition is the best contraception" - whether this is ambition in the teenagers themselves or of the parents.
We must also help parents to support their teenagers.We must also help parents to support their teenagers.
Parents may well disapprove of some of the activities their adolescents get up to.Parents may well disapprove of some of the activities their adolescents get up to.
But they must keep the lines of communication open and let their children know they can come to them when they are in trouble.But they must keep the lines of communication open and let their children know they can come to them when they are in trouble.
What is the right answer? Are doctors being placed in a difficult position when they have to decide whether or not to give teenagers contraceptives?What is the right answer? Are doctors being placed in a difficult position when they have to decide whether or not to give teenagers contraceptives?
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