What qualities do you most want your doctor to have? Good medical knowledge? Honesty? Good listening skills? Empathy? You probably want your doctor to have all of these traits – and teenagers are no different. But young people also place a high priority on confidentiality; a particular concern is that the doctor will disclose their personal information to their parents.
Without confidentiality, adolescents are less likely to seek health care, less likely to disclose sensitive information about their lives and less likely to return for future appointments. But forgoing health care isn’t an option for young people today. According to the Australian Institute of Health and Welfare:
- One quarter of 16 to 25-year-olds have a mental disorder
- One third (35%) are overweight or obese
- 30% are drinking at risky levels
- One in five have used an illicit drug in the past year
- 40% of young people in years ten and year 12 have had sex
- 7% have been the victim of physical or sexual assault.
- Injury and poisoning are the leading causes of death for young people
The parent’s perspective
The problem is a lot of parents want to be told what goes on behind closed doors when their teenager visits a doctor, even if their children don’t want them to know. To find out why, the Centre for Adolescent Health in Melbourne recently interviewed parents of teenagers to find out what influences their views.
All parents thought it was important to support their teenagers in becoming more independent and more autonomous as they grew up. They saw this as a key part of their parental role. But they had very different ideas about how to do this in relation to their children’s health care.
Some parents thought the best way to help their children become more independent was to completely step back – letting them see doctors alone and letting them learn to “stand on their own two feet”. Others believed the best way to support their teens was to know exactly what was going on in all aspects of their lives; including their health care.
The extent to which parents trust their teens’ doctor influences whether they’re supportive of confidentiality. As one parent said, “I would willingly step out if I trusted the doctor to share with me anything I need to be aware of.” The extent to which parents trust health professionals more generally (as opposed to their teens’ doctor specifically) is also a key influence.
Parents’ views about confidentiality also relate to the way they view their role as a parent. For some, stepping out of a consultation and leaving their teenager to see the doctor alone would constitute bad parenting. As one parent stated, “no-one knows your child like a parent does”. For these parents, fulfilling their parental role entails being responsible and active in their teenagers’ lives, sharing important information with the doctor and being there to ask important questions too.
Of course, these parental skills are vital when children are young. But as children grow up and enter adolescence, it becomes more and more important for them to have privacy.
International guidelines recommend adolescents be left alone with their doctor for at least part of each consultation. (They don’t specify an age but teens can access their own Medicare card from the age of 15). This allows them to be completely, 100% honest about what’s going on in their lives. It also gives young people a chance to obtain the skills they need for engaging with health professionals as adults.
Yes, this comes with risks. What if they don’t share all the necessary information? What if they don’t remember what is said? What if they don’t understand what is explained? But these are necessary risks.
The challenge is therefore to find a way to help parents feel comfortable about this and support privacy for their teens.
Health professionals need to prioritise this time alone for young people, despite other competing demands and despite this being an uncomfortable conversation to have with some parents. They may need to invest more time in building rapport with parents (as well as with young people) in order to develop this trust and understanding, and may require additional training and support to do this effectively.
The clinician’s perspective
Health professionals also struggle with confidentiality for adolescents and at times feel unsure about how much to share with parents and how much to keep private.
A recent study of Australian psychologists who work with adolescents found significant variation around when psychologists would breach confidentiality with a young person to inform parents about risk-taking behaviours. One of the reasons for their varied opinions was case-by-case considerations: how mature the adolescent was; whether the parents were likely to be supportive if told; and whether breaching confidentiality would stop the adolescent from coming to see the psychologist in future.
Australian psychologists did show consensus when it came to the extreme categories of risk behaviour, such as suicidal behaviour. In these cases, they agreed parents would need to be informed. This is in line with the Australian Psychological Society’s code of ethics, which stipulates confidentiality should be breached for an immediate risk of harm.
Both parents and health professionals may be in need of some education and support if we’re to realise the goal of providing age-appropriate health care to young Australians. So next time you take your teens to the doctor, give them some space, wait outside and trust that the doctor wants the same things for your teen as you do.