In some circumstances, teenagers can give consent. The law is complex and varies from state to state. Minors typically have the authority to consent to medical care related to sexually transmitted diseases. HPV and hepatitis B vaccines might be included in that. However, there can be practical problems with reimbursement since most teenagers cannot afford to pay for care themselves.
There are also legal intricacies in handling the Vaccine Information Statements. These nuances vary depending on state law, the vaccine type, and in some cases the source of vaccine. Go to
www.cdc.gov/vaccines/pubs/vis/vis-facts.htm#faq
This is an important issue because without following the procedures to the letter, reimbursement for adverse effects may not be available, exposing the physician and the patient to financial risk.
Pediatricians place the patient's needs first, but economics and efficiency are also important when establishing office policy. There are valid reasons why many pediatricians would choose not to vaccinate, or even see, unaccompanied teenagers. But when a survey shows your colleagues have chosen to overcome these reasons and barriers, it should prompt reflection. Could I, and should I, do it in my office as well?
KEVIN POWELL, M.D., PH.D., is a pediatric hospitalist at SSM Cardinal Glennon Children's Medical Center, St. Louis. He said he had no conflicts of interest.
