Confidentiality

What is confidentiality?

Confidentiality is about your privacy, meaning that any information you write down or tell someone about will be kept between you and that person. It is common to confide in friends because you trust them. Keeping certain things confidential is kind of an 'unspoken rule' in a friendship.

What about confidentiality and health professionals?

For doctors, counsellors, youth workers, interpreters, teachers and any other health professionals, confidentiality is part of the law. In most situations, doctors and other health professionals must keep information given to them by patients or clients confidential. However, they are required to report information they receive if they have serious concerns about your or someone else's safety.

In your first session with a counsellor or another professional - they should go through confidentiality with you. They'll let you know how it works and ask you if you have any questions. If you do have questions, please ask them! It's normal to be a bit confused by confidentiality and it's important that you understand how it will affect you. Your counsellor will be happy to answer any questions you have.

It's also important to realise that confidentiality is not broken unless it absolutely necessary. It's not something that health care professionals take lightly. They want to do what's best for you and a decision to break confidentiality only happens after a lot of thought. When a health care professional does decide that it's necessary, your case is still treated with respect and care. The health care professional will only tell those who absolutely need to know, and this is usually a very small number of professional or relevant people.

If you're unsure about what a health professional will have to report you might want to talk to them about what they do, and don't, have to pass on. You might also want to find out to whom they have to report the situation - it could be your family or carer, or the Department of Community Services. In very specific situations it could involve speaking in court or to the police.

If a health professional does have to report a situation they should talk to you about it first.

How important is confidentiality?

The answer is simple; it's REALLY important. Being worried about whether a health professional will keep your experience confidential is normal. Going to see someone might be a new experience and it may take time to understand and trust the person and the system.

It is possible that you or someone you know might have had a negative experience with a doctor or health professional. This might affect your trust in them. If this has happened try to remember that not all health professionals are the same and you might need to find someone who is better suited to you.

Does age make a difference?

Yes and no...

Across Australia, turning 18 means you are legally an adult. All young people aged 18 and over have automatic rights to confidential care. In NSW and South Australia this applies to a young person 16 and over and in the Northern Territory this applies to young people 14 and over.

In other words, even if you live with your parents, you automatically have a legal right to go to a doctor on your own and receive confidential information and treatment no matter what. The doctor must not tell your parents anything without your permission.

The exception to this is for a person of any age (under or over 14, 16 or 18) who may be at risk of killing or seriously harming themselves or someone else. In this situation the health professional might need to break confidentiality in order to keep them safe.

For more information about the legal age to automatic rights to confidential health care in your state you can check out www.lawstuff.org.au

But confidentiality is still your right in almost all circumstances - Even if you are under the age for 'automatic rights' for confidential care (see first paragraph above) you can still go to a doctor confidentially. This means that you can talk about personal things including feelings, sexuality, sex, smoking, drugs and relationships in private.

If the doctor discovers during a conversation with you that there is a serious safety issue involved then they must ask themselves the following question:

Is your safety at risk because of someone else?

If you are under 16 and you let your doctor know that someone is harming you, or has harmed you in the past and it is affecting your health now, then the doctor by law must notify proper authorities in order to keep you safe. This applies in nearly every state and territory in Australia.

The 'proper authority' is a government department that is charged with caring for the welfare of children and young people. This will include things like physical abuse, sexual abuse, emotional abuse, neglect and domestic violence. 

This represents a situation where the doctor must break confidentiality - it is called "mandatory reporting" and the doctor is breaking the law if they don't report it. If you are 17 or 18 years old, the doctor can also choose to report the situation, but it is not mandatory (compulsory). This may be scary and it is really important that your doctor lets you know exactly what will happen and makes sure that you have plenty of adult support - from your doctor, from parents if appropriate or from other appropriate people.

What about being involved in criminal activity?

This depends on the seriousness of the crime. Doctors are not required to report illegal drug use to the police, although other health professionals may be. They are also not required to report underage sex to the police or to anyone else.

The questions the doctor must ask are identical to those above - is your safety at risk, is someone harming you, are you mature enough to make your own decisions about treatment. If you are involved in a serious crime (this can include drug dealing, committing sexual assault, committing physical assault, causing grievous bodily harm and so on) and you tell your doctor, they might be required to report this.

Other health professionals may have to report illegal drug use or underage sex, when you are speaking to a health professional it is a good idea to ask them what they are obligated to report.

What about being able to get medical treatment, such as a prescription for the contraceptive pill, without parents' or carers' permission?

Young people aged 18 and over are legally adults and have automatic rights to make decisions about their own health care or treatment, such as prescriptions for contraception. This process of making your own decision about receiving treatment is called 'giving consent'. Exceptions to this law for young people 18 and over would only be in the case of someone with an intellectual disability or a mental health problem that seriously affects their ability to think clearly and make decisions about their health. 

Some states and territories in Australia have made special laws for young people under 18  to make their own treatment decisions (or 'give consent'). In New South Wales a young person can automatically give their own consent to treatment from the age of 16. In South Australia this law also applies for young people aged 16 or 17, as long as two doctors agree that the young person is mature enough. In the Northern Territory young people 14 and over can automatically give their own consent to treatment.

However, even if you are under the age where you can automatically give consent, you may still be able to give your own consent and receive treatment without parents' or carers' permission. The critical question that the doctor must ask themselves in this situation is:

Is the person they are seeing mature enough to be able to make important decisions about treatment on their own?

If you want or need a particular treatment, for example a prescription for contraception, or counselling for depression, then the doctor must decide whether you are mature enough to give your own consent for this treatment,  meaning that you will get the treatment without the doctor getting permission from your parents or guardians.

In the great majority of cases the answer is YES. In many cases the doctor will talk with you about the appropriateness of involving your parents or guardians in some way even if it's just to let them know that you are going to see them about "some health concerns". If you refuse to let the doctor say anything to your parents or guardians, then the doctor must carry on keeping confidentiality, unless there is a concern about safety, as talked about before.

Obviously the younger you are, the more likely that a health professional will want to involve parents or carers in some way. If it involves an operation (including a termination of pregnancy), it is very likely that the doctor will insist on getting your parents or guardians to consent. Some doctors and hospitals will not give you treatment (for example a termination of pregnancy, or a minor operation) without your parents' or guardians' consent if you are under 14 - but it will depend on each and every situation.

What if I am not fluent in English?

A doctor or other health professional can only decide that a person (young or old) can give consent if they believe that that person can understand all the information being given to them about the treatment. So, if there is a language problem such as having difficulty communicating fluently in English then the doctor or health professional should ask for the assistance of a health care interpreter, with your permission.

Health care interpreters are specially trained professionals who are also bound by law to keep information confidential. They must not tell anyone else, either professionally or personally, about the information they have interpreted for a client, or patient, during a health consultation. Doctors around Australia can use a free "Telephone Interpreter Service" during a consultation if they cannot arrange for a health care interpreter to be there in person. This means that you talk to your doctor in your own language and the interpreter repeats what you say to the doctor in English, and vice versa (they repeat what the doctor says to you in your language). You can ask your doctor for a health care interpreter, or alternatively your doctor can ask you if they can arrange one for you both when you have your appointment.

What about confidentiality and friends?

If your friend has told you that they are feeling suicidal or are in an unsafe situation, don't promise to keep it a secret.

Secrets can be dangerous if someone is going to get hurt or die. It is important to tell someone who can assist you and to encourage your friend to talk to someone (separately). This may be a counsellor, teacher, youth worker, religious leader or social worker. The Finding Help section can give you more information about how these people can help. To find out who is available in your local area, check out your local phone book.

What happens with Medicare?

If you are an Australian citizen or permanent resident you can be enrolled in Medicare, which means you have an automatic right to health services that are covered by Medicare. These include such things as being seen for free in a public hospital, community health service, psychology services in certain circumstances (see psychology fact sheet for more info), or by a general practitioner who charges Medicare only (also called bulk-billing). Even if you have to pay your doctor for seeing them, you can claim some or most of it back from Medicare (get some or most of your money back).

Most families have 'family Medicare cards' which means that your name appears on the same card as your parent/s and brothers or sisters. When you turn 15 you are legally allowed to apply for your own Medicare card. To do this, you need to go to a Medicare office with identification and apply for your own card. This means that when your family Medicare card is due for renewal, your name will be removed from it.

Even if you don't have your own card (because you're not 15, or because you don't want one), you can still receive health services, such as bulk billing from a general practitioner, if you can give them your Medicare number. You can write down your Medicare number from your family's Medicare card and keep it with you to use when you need to.

Your parents/ guardians cannot ask a doctor to give them information about you without you giving the doctor permission, even if you have used the family Medicare card. The most they can find out (if they can't talk to you about it directly, which is obviously preferable) is whether the Medicare card has been used (but not what for). If you have your own Medicare card, they can't find out anything from Medicare about whether the card has been used.

Acknowledgements

Our thanks to the NSW Centre for the Advancement of Adolescent Health who prepared this fact sheet.