Please Don't Tell My Mom
An established 15-year-old patient comes to her pediatric clinic with her mother, who reports "stomachaches." The certified Spanish interpreter is in the room. The pediatrician asks the mother to step out for the adolescent portion of the visit. Alone with the clinician and interpreter, the girl says she has been cutting her forearms for four months and has had thoughts of "not being here anymore." She then turns to the interpreter: "Promise you won't tell my mom. Promise me." The pediatrician pulls up the PHQ-A on a tablet; the English version loads, the Spanish version does not. She hands the tablet to the interpreter: "Read her the questions and tell me if she's at risk." The mother is knocking, asking whether the visit is almost over. The clinic has a behavioral health consultant who is with another patient for 20 minutes.
1. How do you answer the girl's request for a promise?
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Do not promise. A promise you may have to break within the hour would damage exactly the trust she is trying to build, and it would put you in charge of a decision that is not yours. Answer warmly and honestly, in her language, at her level: "I can't promise to keep this from your mom, and I won't lie to you about that. What I can promise is that I will interpret everything you say so the doctor understands it, and I will make sure your worries about your mom are heard."
Then hand the confidentiality question to the person who can actually answer it. Tell the pediatrician, in the room and in front of the girl, that she asked you not to tell her mother. The clinician - not the interpreter - must explain what will be shared with a parent, what will not, and what the clinician is required to disclose when a minor is at risk. Interpret that explanation exactly, including the parts the girl does not want to hear. Do not soften "I have to tell your mother" into something vague, and do not imply a legal rule you are not sure of; let the clinician state it.
Afterward, watch for the girl going silent or giving short answers because she feels betrayed. That is information for the clinician. Report it as behavior, not as a conclusion: "She has stopped giving detail since the confidentiality discussion."
2. The pediatrician says, "Read her the questions and tell me if she's at risk." What do you do?
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There are two separate problems, and one of them is urgent. First, the instrument. The PHQ-A is standardized; sight translating the English items on the fly creates an unvalidated version, and item wording shifts scores. Ask for the validated Spanish PHQ-A to be loaded, and if it cannot be, have the clinician administer the items verbally while you render each item faithfully - unchanged, in order, without adding examples or "what she means is." The clinician scores; you do not.
Second, "tell me if she's at risk" is a clinical judgment and outside your role. Your contribution is accuracy and completeness: render the girl's exact words, including idioms, and flag them without replacing them. If she says "me quiero desaparecer," give the literal rendering and tell the clinician it is an idiom that can carry the sense of wanting to vanish or die. Do not paraphrase item 9, do not round "sometimes" into "no," and do not interpret a shrug or silence as a denial - report it as a shrug. Preserve duration and frequency exactly (four months, how many days in the past two weeks).
Finally, note the timing: a behavioral health consultant is free in 20 minutes, and a warm handoff is safer than a discharge with a phone number. Say that to the clinician once, as information, and let her decide.
3. The mother is knocking, and the girl has asked that her mother not be told. How do you handle the disclosure to the mother?
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The clinician decides what is disclosed and delivers it; your job is sequencing and accuracy. Before anyone opens the door, ask the clinician to tell the girl first, in your interpretation, what her mother will and will not be told and why. A 15-year-old who learns the content at the same moment as her mother, in front of her, experiences it as exposure rather than as care, and she still has to go home with this woman tonight.
When the mother comes in, interpret exactly what the clinician says - no softening, no cushioning phrases the clinician did not use, and no added reassurance of your own. Expect distress, anger, and questions aimed at the girl; interpret all of it, and do not become the go-between who explains or smooths things over. If the mother turns to you and asks, "Is this true? What did she say?", redirect once, clearly: "The doctor will answer that," and interpret the clinician's answer.
Manage the room practically: keep the girl's account and the mother's account distinct and attributed ("she says," "you are saying"), and do not merge them into one narrative. If the girl shuts down, tell the clinician what you observe. Document that the minor's confidentiality was addressed by the clinician, that the disclosure conversation was interpreted, and that a behavioral health handoff was or was not arranged.