College students face many of the same health problems as younger students, but the legal problems are more complicated. The college student is often away from home and without the usual support system in times of illness. Dormitories do not provide chicken broth and dry toast to every student with the flu. They may even be the source of food poisoning, measles, epidemic respiratory disease.

As in other school settings, the physician’s duty is to the patient, not the institution. If the college food service is a frequent source of food poisoning, the college physician should insist that something be done to correct the problem. Physicians must not change the diagnosis from food poisoning to gastroenteritis of unknown origin to avoid political problems. They should work with the college administration to address particular health problems, but medical judgments should not be compromised for administrative convenience.

Issues of consent and confidentiality do not change when the patient is a college student. All residential schools should have a power of attorney to consent to medical care for students who are still minors. It is risky to assume that they will all stay healthy until they reach their majority. This is especially important for minors who are far from home, particularly international students. It is also useful for students who are not minors to consider a power of attorney to consent to medical care if their parents are not readily available or if they do not want their parents involved in their medical care decisions.

College physicians must respect the students’ confidentiality. The fact that a parent may be paying the tuition or medical bills does not give the parent the right to medical information about a child who is not a minor. At the same time, the parents of a college student have the reasonable expectation that they will be contacted if the student is in trouble or requires significant medical care. The university should require students to sign a waiver that allows it to contact the student’s parents in such circumstances. (The university should allow exceptions for students who are estranged from their parents.) For certain kinds of care, such as treatment for drug abuse or venereal disease, the information should be protected unless the student requests that parents be notified. However, students must understand that they may have to pay for the care if they want to keep it confidential. The physician should explain to students who ask that something not appear on a bill that few parents and no insurance company will pay for unspecified services.