Article date: 11 May 2006
With reports of Britain’s teenagers dealing with growingproblems of drugs, poor diet and underage sex, GPs admitthey’re becoming increasingly concerned about keeping parentsin the dark about teenagers’ health matters.
New research reveals that nearly one in three (30%) GPs are callingfor a review of current patient confidentiality guidelines to giveparents of under-16s the "right to know" on health mattersincluding pregnancy and sexual health. Over 90% of parents believethey have the "right to know" about such matters.
Figures from Norwich Union Healthcare’s latest "Health of theNation Index", a study of 250 GPs nationwide, reveals the issuesGPs believe parents of young people should be informed about:
- Drug misuse - 38%
- Alcohol misuse - 37%
- Eating disorders - 32%
- Sexual health matters- 18%
Under current confidentiality guidelines, GPs are required tokeep quiet about all teenagers’ health matters1.Parents may therefore be unaware of the following2:
- If their 14 year old son was being treated for a sexuallytransmitted infection
- If their teenage daughter was prescribed the pill despitepotential dangers of family medical history (eg inherited tendencytowards blood clots/thrombosis)
- If their 15 year old daughter was having a termination
- If their 13 year old son visited his GP about regularlydrinking half a bottle of vodka in a single sitting.
However, one-in-25 (4%) GPs feel so uncomfortable with thecurrent situation that they have already breached confidentialityguidelines and informed parents of teenage patient’s healthproblems before gaining prior consent from the patient, potentiallyrisking legal action under English common law.
London GP and member of the GP panel, Dr Ann Robinson, comments:“GPs will always encourage teenagers to involve a parent orresponsible adult but some teenagers refuse. Involving parents canbe crucial for a number of reasons: young people need emotionalsupport when undergoing treatment; parents may need to inform GPsof important family medical history; GPs need to understand teenagepatients’ backgrounds as problems such as depression canimpact on the whole family; finally, solutions to problems -especially lifestyle problems - must involve the whole family. Theresearch suggests that parents and GPs want a more open dialoguewhich addresses the teenagers’ needs first and foremost butalso doesn’t shut parents out.”
GPs seem unconvinced by claims that, without guaranteedconfidentiality, teenage patients will have nowhere to turn forimpartial advice and support.
Almost one-third (29%) of GPs believe that granting parents theright to know about treatment or advice their teenager is receivingwill have no detrimental impact on levels of teenage pregnancy inthe UK. Almost one-in-five (17%) believe it could have a positiveimpact on these levels.
The same is true of sexual health matters, with the same number(29%) believing that granting parents a right to know would have nodetrimental impact on the level of STIs among teenagers in the UKand 17% believing it could even reduce the number of cases.
Research suggests that the vast majority of British parents supportGPs in this view. They believe they have the right to know if theirchild receives advice on any matter relating to the following:
- Eating disorders 94%
- Alcohol misuse 93%
- Drugs misuse 93%
- Sexual health 86%
To help parents address difficult subjects including sexualhealth, drugs and alcohol with their offspring, Dr Ann provides thefollowing advice:
- Do your homework. Speak to your GP, the school nurse or localfamily planning service to find the most teenage friendly placethat your son or daughter can go for expert advice. Then give themthe phone number
- Keep channels of communication open. The most natural way tocommunicate is whilst doing something you both enjoy; a swim orshort jog or perhaps an evening out at the cinema
- Stay positive and be loving and supportive. There may beaspects of your teenager’s behaviour that are challenging,but they need to keep being told that it doesn’t challengeyour intrinsic love for them
- You are the parent, not their friend. Teenagers needboundaries. Pick your fights carefully.
Dr Doug Wright, clinical spokesperson for Norwich UnionHealthcare, continues: “Patient confidentiality is sacred andthe trend for GPs to breach guidelines on the subject is a measureof the complicated nature of managing young people’s healthissues. GPs stress the importance of clear communication betweenparents and their teenage children so that parents become aware ofthe advice and treatment that is given by a GP to their children.Honesty and trust will give parents and teenagers the very bestchance of dealing with these issues.”
The Health of the Nation Index is a bi-annual research programmetracking the views of the UK’s GPs. Now in its fourth year,the latest report forms the seventh tranche of research undertakensince the Index was first launched in April 2003. Highlightsinclude:
- 44% of GPs have avoided raising the issue of weight withobese/overweight patients
- 20% of GPs have withheld treatment because of apatient’s unhealthy lifestyle
- 44% of GPs would be prepared to work more flexible shiftpatterns to ensure surgeries could offer longer opening hours
- Contentment at work for GPs remains steady, with 51% ofdoctors expressing high/very high levels of job satisfaction
- GPs believe that faster and more reliable diagnostic serviceswould most improve patient experience of the health service,followed by shorter waiting lists and longer appointments withGPs
Roger Taylor, research director at Dr Foster Research Ltd whocarried out the research, said: “The findings show thedifficult personal and moral challenges that GPs face in theirdaily practice – raising difficult personal issues withpatients, deciding whether or not to refer patients with poorlifestyles and respecting the confidentiality of children. Butdespite these difficulties GPs display high levels of satisfactionwith their work and, encouragingly, many are willing to work moreflexibly to improve patient access to services.”
Full details of the Health of the Nation Index report can beaccessed at www.healthofthenation.com
Chris Lauwerys or MelanieCorbett, Lexis Public Relations on 020 7908 6488
Norwich Union Press Office contacts:
Cheryl Cox: 07800695 275 or 01904 452617
Notes to editors:
1GPs are required to keepquiet about teenagers’ health matters unless the teenageragrees to involve a parent or responsible adult, is unable tounderstand all the issues or there are child protection issues.
2Whilst there is no lower age limit - meaningchildren as young as 13 can be treated without their parentsknowing - Department of Health guidance stresses the importance ofconfidentiality for under 16s. Health professionals must take thetime to explore whether individual cases involve coercion or abuse.Where there is cause for concern the case would be referred throughchild protection procedures. The DoH has also developed guidance inthe wake of the Victoria Gillick case.
The Gillick case established that health professionals arejustified in giving contraceptive advice and treatment to under 16swithout parental knowledge or consent provided that certainconditions are met.
Doctors and other health professionals are expected to follow thecriteria outlined by Lord Fraser in 1985 in the House of Lords'ruling in the case of Victoria Gillick v West Norfolk and WisbechHealth Authority and Department of Health and Social Security.These are commonly known as the Fraser Guidelines:
- The young person understands the health professional'sadvice
- The health professional cannot persuade the young person toinform his; or her parent or allow the doctor to inform theparents that he or she is seeking contraceptive advice
- The young person is very likely to begin or continue havingintercourse with or without contraceptive treatment; unless he orshe receives contraceptive advice or treatment, the young person'sphysical or mental health or both are likely to suffer
- The young person's best interests require the healthprofessional to give contraceptive advice, treatment or bothwithout parental consent.
Case studies available on request.
Norwich Union Healthcare commissioned Dr Foster Research Ltd toconduct research amongst approximately 250 practicing GPs fromacross the UK in September 2005.
All figures, unless otherwise stated, are from YouGov Plc. Thetotal sample size was 2,598 and fieldwork was undertaken between12th and 18th April 2006. The survey was carried out online and thedata is weighted to be representative of the GB population (aged18+).
About Norwich Union Healthcare
- Norwich Union Healthcare was founded in 1990 as the healthcarearm of Norwich Union and now provides a range of income protectionand private health insurance products that cover over 870,000lives. It is one of the largest providers of income protection andprivate health insurance in the UK.
- Norwich Union acquired Occupational Health provider, PrivateHealth Care, in October 2005. We now offer an extensive range ofoccupational health services to corporate clients. These servicesare delivered by Norwich Union Occupational Health Ltd.
- Norwich Union Healthcare is authorised and regulated by theFinancial Services Authority and is a member of the Association ofBritish Insurers and the Financial Ombudsman Service.
- Norwich Union’s news releases and a selection of imagesare available from Aviva’s internet press centre atwww.aviva.com/media.
About Dr Foster Research Ltd
- Dr Foster Research Ltd is the leading independent authority onhealthcare quality in the UK. Its information can be accessed viapublications such as the Hospital Guide and online at www.drfoster.co.uk.
- Dr Foster Research Ltd is the sister company to Dr FosterIntelligence, which provides expert analysis to the NHS.
- An independent Ethics Committee with substantial powers toenforce editorial and research integrity oversees theorganisation.
- Further information is available at www.drfoster.co.uk ordirect from Dan Collins, Client Services Manager, DF Research, 17St Helen’s Place, London, EC3A 6DG.