Informative privacy and confidentiality for adolescents: the attitude of the Flemish paediatrician anno 2010

Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier for an adolescent to seek medical care. Little is known about the right on informative privacy and confidentiality for adolescents in Belgium, although these rights are unambiguously foreseen in the law on patients' rights since 2002. There are no data available regarding the introduction of a private moment with the physician during a consultation, about the nature and the quantity of information made available to parents by the paediatricians regarding the health situation of adolescents and about the existence of procedures with regard to these matters. The purpose of this study is to map out the current interpretation and the attitude of the paediatrician with regard to the right to confidentiality and informative privacy. The answers of 117 Flemish paediatricians to an anonymous questionnaire were analyzed. An unaccompanied medical visit is not frequent in Belgium (only 1%). Only 35.1% of the paediatricians systematically offer the possibility to have a private conversation with an adolescent. Almost 80% of the paediatricians render, as a rule, all information to the parents. Parents are informed about sensible information regarding psychosocial aspects, including data concerning sexual behaviour, in not less than 83.2% of the consultations by adolescents. Only in 2.9% no information is given to the parents. The paediatricians employ only for 13% the procedures regarding confidentiality for minors. This study reveals that Flemish paediatricians have a paternalistic attitude concerning the right on confidentiality and informative privacy, which is not in line with the Belgian legislation. Paediatricians offer only seldom the possibility for a private conversation to the adolescent. The small incidence of unaccompanied medical consultations contributes to this. Proper application of the legal context, the handling of the watertight procedures and the necessary communication in this respect is indispensable for the confidence and will lower the barrier for adolescents to use the healthcare system.