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As the U.S.’s mess around medicare for all continues, this company has decided it doesn’t have any more time to waste at the cost of people’s lives
Teens and confidentiality
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When my primary care patients reach high school age, or sometimes before, I kick their parents out of the exam room.
I don’t do it right at the beginning of the visit. I meet with them both first, to see what the parents are worried about (teens don’t always tell me), and to get updated on what is going on with the family (teens don’t always know). Then I ask the parents to leave. I say that at their child’s age, I like to have some time alone with them.
I have a standard speech I give the teen. I say, “Anything you tell me is confidential, and your parent won’t be able to read the note I write. If you tell me anything I think your parents should know, we will talk about how to tell them. I won’t go behind your back.”
I can’t imagine doing it any other way. It’s what my teen patients need me to do.
Why does confidentiality matter?
In a study published this year in the Journal of Pediatrics, researchers asked youth ages 14 to 24 about their opinions and experiences with confidentiality in their health care. They found
- most had not had a conversation with their provider about confidentiality
- many thought all care should be confidential
- youth worry about privacy and future discrimination
- youth may lie about their risk behaviors or not seek health care when concerned about confidentiality.
It’s that last point that worries me the most. As anyone who has been a teen knows, there are things you don’t always feel comfortable discussing in front of a parent or guardian.
That might include things like sex or sexuality, meaning a teen could miss the opportunity to learn about or get birth control, get treatment for a sexually transmitted infection, discuss healthy relationships, or explore questions or feelings about sexuality.
It might include substance use, meaning a teen could miss the opportunity to get the advice they need to make safe and healthy decisions about substance use — or the help they need for a substance use disorder.
It might include mental health concerns such as depression or anxiety, meaning a teen could miss the opportunity to get the mental health help they need.
Sometimes there are physical concerns that a teen doesn’t want to talk about in front of a parent — because they think it is silly, or because they are embarrassed, or because they don’t want to worry their parents. They could miss the opportunity to get the treatment they need — or be reassured that they are fine.
This is not what we want for our teens.
Advice to parents about teen confidentiality
I understand that it can be hard for some parents to let their teen have confidential alone time with their health care provider. It’s normal to worry, and to not like the idea that they could keep secrets from you. It’s also normal to wonder if you can really trust the health care provider, or whether their values are the same as yours.
But besides the fact that what is most important is your child’s health and safety, the unavoidable truth is that teens grow into adults who need to learn to advocate for their own health and well-being. The best way to learn to do something is to practice it.
That’s why my advice to parents is to not just let their teen have confidential time with their health care provider, but to encourage it. If the doctor doesn’t ask you to leave the room, offer to do so — and make it clear that you don’t need to know what they talk about.
Follow me on Twitter @drClaire
The post Teens and confidentiality appeared first on Harvard Health Blog.
Pain Relief For Very Sick Kids Is The Focus Of This Quick Response Team: An interdisciplinary team in San Francisco uses acupressure, massage, counseling and other methods, as well as medicine, to help kids get relief from chronic pain. But such pediatric centers are rare.
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You Aren’t a Narcissist, But Could You Be an Echoist?
Most of us are familiar with narcissism. In fact, most of us probably know a narcissist or two. Those people who have enormous, self-serving egos and an inflated sense of importance. These people can often seem charming, but have a difficult time sustaining relationships and friendships because ultimately they use people around them to fuel their sense of self-worth. Often times the person drawn to the narcissist is an echoist, or someone who feels like their only purpose is to serve someone else. In other words, they are the precise opposite.
Echoism is a fairly new term for a personality type that many of us might be familiar with — the people pleaser. In the recent years Harvard psychologist Dr. Craig Malkin has done work defining echoism and the traits associated with it. And, although very different than narcissists, echoists are considered to fall on the spectrum of narcissistic personality disorders. It should be noted, however, that echoism isn’t yet listed in the DSM as a formal classification of personality disorder, but it is gaining recognition as a problem.
What Is Echoism?
Again, echoism is the opposite of narcissism. Echoists are often people who feel the need to take care of others at their own expense. They shy away from any form of praise or recognition, instead wishing to remain anonymous and in the shadows. So, where a narcissist is selfish and self-centered, an echoist is generally someone who feels uncomfortable in the spotlight or receiving praise or recognition of any kind. They have an almost phobic like fear of seeming narcissistic in any way.
Most echoists have been made to feel inferior for a large portion of their lives. Nothing was ever good enough regardless of how impressive their achievements may have been. As a result they have lived their lives believing that others were better or more worthy of love and praise. And because of this belief strive to serve, impress, and fill the needs of other people. Very often these people are narcissists.
Narcissists require others to feed their ego and make them feel as though they are superior to people around them. Because of this echoists are often drawn to them. A narcissist wants and needs to have their ego fed, and an echoist feels that serving others is their purpose in life. Unfortunately, this is an unhealthy interchange and often leads to abuse such as the narcissist blaming any shortcoming on the echoist and driving their self-esteem lower.
Echoism tends to be associated more with women than men. Circumstances and social pressures can push a female who is already battling issues with self-confidence and self-esteem into more subservient roles. Because there is historical precedence for women such roles, the problem can often go unnoticed on an individual basis. Too often this leads to abusive relationships that go on for years.
An Echoist Isn’t the Same as an Introvert
Because they are often quiet and reserved, many people mistakenly confuse introverts and echoists. It’s an easy mistake to make. Echoists and introverts share many similar traits. The problem with confusing these things is that being introverted doesn’t mean you are unhealthy. Echoism, however, is distinctly unhealthy and leaves a person open to being taken advantage of and abused.
Some of the common traits that lead to confusion are as follows:
- Quiet and unassuming.
- Steering clear of the spotlight.
- Disinterest in large social gatherings.
- Discomfort with compliments or praise.
But echoists and introverts are quite different. In fact, many echoists are quite successful in their chosen fields, they just don’t want the credit and never enjoy a sense of accomplishment. They may instead feel more comfortable allowing others to claim the results of their hard work.
Echoism, like narcissism, is unhealthy. It leads to relationships that are dysfunctional, one-sided, and potentially abusive. Although an echoist may think they are doing what they need to by taking care of, or serving others, they are really denying themselves the happiness that a healthy, well-balanced individual should enjoy.
So what should you do if you believe you or someone you love suffers from echoism? In all likelihood counseling or therapy will be needed. The origin that help create the personality associated with echoism are typically too deeply ingrained to deal with alone.
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