Some years ago, in the candor of the exam room, a seventh-grade boy told me that he didn’t really have friends at school, and that he sometimes found himself being picked on. I gave him the pediatric line on bullying: it shouldn’t be tolerated, and there are things schools can do about it. Let’s talk to your parents, let’s have your parents talk to the school; adult interventions can change the equation.
And he was horrified. He shook his head vehemently and asked me please not to interfere, and above all not to say a word to his mother, who was out in the waiting room because I had asked her to give us some privacy.
He wouldn’t have told me this at all, he said, except he thought our conversation was private. The situation at school wasn’t all that bad; he could handle it. He wasn’t in any danger, wasn’t getting hurt, he was just a little lonely. His parents, he said, thought that he was fine, that he had lots of friends, and he wanted to keep it that way.
When treating older adolescents, pediatricians routinely offer confidentiality on many issues, starting with sex and substances. But middle-schoolers are on the border — old enough to be asked some of the same questions, but young enough that it can be less clear what should stay confidential.
