Thursday, December 11, 2008

Where to draw the line in Doctor/Patient Confidentiality

 

(http://www.nytimes.com/2008/12/09/health/09klas.html?_r=1&ref=health)
On a majority of people's minds come the question of what your pediatrician considers to fall under doctor patent confidentiality. When you are an adult, your business is of course private when it falls under medical or psychiatric means. Yet when treating children comes a whole new set of challenges doctors face when it comes to confidentiality. In the article above, Dr. Perri Klass talks about times when a decision must be made upon whether to inform the child's parents or not. 
Most of the issues rely upon really how serious the issue is, but then again, how can one classify an issue if what seems not too big of an alarm can later turn into huge problems for this child later in life perhaps due to no one telling the mother of what the child is doing. Lets say for example, a child talks about sharing an alcoholic beverage once with a friend at a young age of lets say 12. What would you do as a doctor if you know this could, even though would seem unlikely, effect the child in a long run if these activities are continued? As a parent, we would all want to know exactly everything our child does, but as a doctor, you have to make the decision upon whether you should tell the child's parents. Where you draw the line really falls into a obscure zone of what’s auk and what’s not. There is no real way to label it or to classify what’s "Ok," and what’s "Not Ok." 
Dr. Perri also draws the idea of, well if we do then report these activities to the parents ,even though the child specifically asked you not to and who has felt comfortable to have you gain their trust, what then happens to that relationship? Most likely the child will no longer want to discuss such things and perhaps hurt them even more in the long run by not wanting to share anything due to trust issues with others and insecurity. When it comes to children, the line is a very thin tight rope doctors must walk in order to make a fair decision on children especially in the age group of most Middle School due to how those years are the most developing ones in their lives. 
In my personal opinion, from this article, it is a doctors duty to protect the privacy of each person, but when you are under 18, to a certain degree, parents do have a right to know if you are engaging in activities that threaten your life, the lives of others, or if others are threatening you "bullying, parental abuse"( in which case the authorities would have to be contacted). I feel personally that the boundaries lay upon personal well being. If the issue does not cross into those boundaries, then it most likely does not require the parents involvement. If anything, the doctor may hint towards the subject with parents by talking about as example by Dr. Perri Klass to say "The child did not want her mother to know, and the pediatrician, who had known her since infancy, negotiated a compromise: the doctor would advise the mother that the girl needed counseling, and as long as she went to counseling, and discussed the drinking and her underlying issues with the counselor, the pediatrician would not tell her mother about the liquor." (Klass Perri.) 
From this idea, I too agree with making a compromise by allowing the child to feel not violated in their trust with you, but also acknowledging the fact that the child needs help and the parents should be taking a bigger interest into what their child is doing. By doing this, The child still feels in control with their life with their privacy intake, while giving the parents a needed heads upon how their child may need help if not from you, then someone else. It is when I feel doctors do nothing is unacceptable when the activity puts he child's life in danger and the doctor tells no one. The whole idea itself is quite interesting, for this not only involves a doctor, but family and friends aswell and their obligations towards other when you hear about dangerous activity that threatens a loved ones life. What to do is the ultimate question that is never a straight answer. When it comes down to it, they are always personal calls based upon each person making it very hard to say what is ok and what in unacceptable for each person.