Adolescent Confidentiality and Consent in an Emergency Setting.

OBJECTIVES: The adolescent population comprises a large volume of emergency department visits each year. A recent study showed that 20% of the ambulatory care visits of adolescent patients aged 15 to 25 years were made to the emergency department. This specific population often has poor access to health care and often is a vulnerable population, causing medical care to be a challenge. The purpose of this article was to review the standard practice and the specific laws regarding confidentiality and consent when treating an adolescent patient to provide the best possible care and treatment. METHODS: A comprehensive literature search was done to examine key aspects of adolescent confidentiality and informed consent in an emergency setting. The literature was then compiled into a review article. RESULTS: The article outlines the specific laws for emergency providers to be aware of regarding patient confidentiality and consent. The adolescent patient can consent to medical care without parental consent, when involving emergency care, contraceptive services, sexually transmitted infections, prenatal care, drug or alcohol related care, mental health services, and sexual assault services. Also, emancipated minors and mature minors are both situations in which a minor has the legal authority to refuse care and make decisions regarding their health care. CONCLUSIONS: Patient confidentiality and informed consent are complex and complicated topics when dealing with the pediatric patient. Although some laws may vary state to state, there are specific details regarding adolescent confidentiality and informed consent that every provider should be aware of. The adolescent population is more likely to seek emergency care if the visit is confidential and the patient feels a sense of trust. Although it is important for providers to respect patient confidentiality when treating adolescents, it is also important for providers to encourage adolescents to confide in their parents regarding health issues.

Changes in Health and Well-Being during Residents' Training.

OBJECTIVES: Previous studies have characterized the negative effects of graduate medical education on physicians; however, there is limited longitudinal data on how physicians' well-being changes during their training. This study aimed to demonstrate and quantify changes to trainees' wellness and health habits during the course of their first 2 years of graduate medical education. METHODS: A longitudinal survey study of postgraduate year 1 trainees at the Cleveland Clinic was administered at 3 time points: the initial survey during orientation week, a second survey at 1 year, and a final survey at 2 years. RESULTS: Of the 170 trainees contacted, 59 (35%) completed the initial survey and 34 (58%) completed the first follow-up survey. Between the initial survey and the first follow-up survey, respondents reported that their health was worse than the prior year (P < 0.001). They also reported sleeping on average 1 hour less per night and exercising on average one fewer day per week. The number of individuals who reported not eating breakfast increased by 22%, whereas the number of individuals eating out at lunch more than doubled. Twenty-seven people completed the second follow-up survey. Between the first follow-up survey and the final survey, respondents gained on average 2.12 lb (P = 0.039). Breakfast, lunch, and sleeping habits persisted through the second follow-up survey. CONCLUSIONS: Residents' health and wellness habits deteriorated during internship and did not improve in the second year of residency. Efforts to promote healthy habits in this population should be a priority.