Juvenile detention: another boundary issue for physicians.

It is estimated that there are 500,000 youngsters in detention in the United States per year. Detention facilities offer a unique environment in which adolescents at high risk for medical problems can be identified and treated. A health care program within the secure juvenile detention facility for New York is described in order to demonstrate how an academic medical center can effect improvement in the health status of underserved, incarcerated youth while meeting professional educational objectives for health trainees. Results of medical services are given for the past 11 years. Medical problems were diagnosed in 46% of the 47,288 adolescents examined. The conditions were grouped into those related to the legal status of the youngsters, socioeconomic background, and/or the institutional setting. The interrelationship of medical conditions with legal, ethical, and youth advocacy issues were demonstrated. The setting affords on opportunity to train primary care physicians with special emphasis on issues such as the nature of the doctor-patient relationship, confidentiality, and patient advocacy, while providing a necessary service to medically disadvantaged adolescents.