Confidentiality and your doctor...

Many young people worry that the doctor might discuss details of a consultation with their parents. They may fear that the parent might phone the doctor to check up on what has been discussed. They might even fear visiting the surgery in case the receptionist might reveal to the parents that the young person has been in to see the doctor.

In many respects the doctor has assumed the role of a latter-day priest and his consulting room has become a confession box.

The doctor patient relationship is unique. Despite the litany of medical controversies in recent years most people continue to speak in very positive terms about their relationship with their family doctor. The relationship is quite different and distinct from the way people relate to other professionals. I don't think that people feel quite the same way about accountants, solicitors, architects or bankers. That is not to say that other professionals are of a lower standing to the doctor. It is just that the nature of the relationship is different.

During the course of a lifetime a person may avail of the services of different solicitors or accountants but they will often retain the same general practitioner. People value the personal continuing relationship they enjoy with their doctor. In many cases the general practitioner is regarded as a valued friend. Although a person might not socialise with their doctor they know that the doctor is somebody they can implicitly trust and can turn to when they need help.

This special relationship has not simply originated out of the blue. There are several reasons why it has evolved in this special way. One of the key reasons is the confidential nature of the relationship.

Embarrassing issues

People tell the most extraordinary stories to their doctor. They also give permission to the doctor to perform physical examinations, which at times can be a very embarrassing experience. They should do so confident in the knowledge that no matter what has been said or done the details of the consultation will not be discussed elsewhere without the patient's permission. This trust in the doctor has been hard earned by the medical profession over many generations.

Just as with the priest, breaching a confidence has the most serious consequences for the doctor and could result in disciplinary action from the Medical Council. Confidentiality is a serious matter and is not regarded lightly by doctors.

However, evidence suggests that young people may believe that different standards of confidentiality apply to them as opposed to adults. One may well ask why would they think that different standards apply to them?

Child health

Adolescence is essentially a time of transition and the young person has many adjustments to make as he matures. In the recent past that young person will usually have attended the surgery in the company of a parent. During the consultation various aspects of the child's health would have been discussed between the doctor, parent and the child.

The child would have been quite secure within that setting because the child would have observed the parent relating to the doctor in an attitude of trust. The doctor might also have been perceived by the child as a parent like figure.


'Young people need to know that if they need medical help with
regard to sexual activity that they can do so without the matter
being brought to the attention of their parents'.

As the child gets older and enters the early teenage years a slight feeling of awkwardness can develop in the relationship with the doctor. The child develops an increasing sense of independence and may not want the parent present for the consultation with the doctor. Some parents resolve this difficulty by being present at the introduction to the consultation and then excuse themselves as the young person and doctor continue with the consultation alone.

Over the years several young people have said to me 'please don't tell my parents about this'. I know from discussions with other doctors that the posing of this question is quite common in general practice. I suspect that this comment is made because many young people are not quite sure where they stand in relation to confidentiality.

Sexuality

The issue of confidentiality comes into sharper focus still if the young person needs to consult with the doctor on any matter related to sexuality. It is a reality of modern life that young people are becoming sexually active at an earlier age. Young people need to know that if they need medical help with regard to sexual activity that they can do so without the matter being brought to the attention of their parents.

They need to know that they can visit their doctor for a confidential discussion about the pill. They need to know that if they are fearful of the possibility of having a sexually transmitted disease that they can visit their doctor and discuss the matter in total confidence.

Some young people resolve this matter for themselves by not going to their family doctor. They might consult with another GP in their area or they might go to a family planning clinic. Both options are very sensible choices because at least the young person has had the good sense to get professional advice. However they need to know that the same confidential advice would be available to them from their own GP.

Some parents will probably feel very uncomfortable with the comments I have just made. Part of their discomfort may derive from the fact that they have not yet adjusted to the fact that their son or daughter is sexually aware. Parents may feel that the comments I have made are an offence to their own moral code. Some may even believe that my comments constitute a form of condoning of early sexual activity.

Over the years I have had several consultations with young people regarding contraception. Several of these consultations ended without a prescription for the pill being issued. Having had an opportunity to discuss the matter some of these young people became empowered to say that they didn't yet want to embark on a sexual relationship. Others did leave with a prescription for the pill and at least had protected themselves from an unwanted pregnancy.

Young people need to know that the rules of confidentiality that apply to them are exactly the same as the rules that apply to their parents. Perhaps this is an aspect of the doctor patient relationship that needs to be promoted more especially to young people.

Written by Leonard Condren, medical editor of irishhealth.com


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