Advice line dilemma - Self-harming teenage girl

A 14-year old girl visited her GP because of headaches. When she rolled up her jumper sleeve so he could take her blood pressure, he noticed superficial cuts on her upper arm and some scarring. When asked about this, the patient admitted she had been cutting herself for the past six months because it seemed to help with the pressure she was under at school. She begged the GP not to tell her parents as she was worried about their reaction. However, he was worried the girl was at risk and contacted us for advice.

Our advice

If the teenager has capacity to make this decision, then the GP owes the same duty of confidentiality to her as to her adult patients. If the patient was unable to trust him not to disclose information without her consent, it may deter her from seeking help in future and, given her already vulnerable state, this could be detrimental to her health.

In line with the GMC's 0-18 years: guidance for all doctors, every reasonable effort should be made to encourage the patient to involve her parents. The guidance also says that doctors should usually respect a young person's decision not to do so if they have capacity.

Doctors can only disclose information about a competent young patient without consent if required by law, if there is an overriding public interest which outweighs their right to confidentiality or where disclosure is in the best interests of a young person who does not have the maturity or understanding to make a decision about disclosure. In this case, sharing information with the girl's parents may be in her best interests because it would enable them to understand the pressure their daughter is under and provide support.

The GP would be wise to assess the young patient's capacity, the level of risk to her and discuss the case with a specialist or a child protection lead before deciding whether to disclose information.

If he decides that disclosing information to the girl's parents without her consent is justified in her best interests, the GP should still tell her of his intentions, unless that would undermine the purpose of the disclosure or put her at increased risk. He should also record the decision and the reasons for it in the patient's notes. The disclosure should be made promptly and be the minimum necessary for the purpose.

Outcome

The GP asked the patient to return to the surgery the following day for a further consultation when he explained to her why he felt it important to involve her parents. The patient reluctantly consented and the GP arranged a home visit to talk with the family. With the support of her worried parents, the girl was referred to the mental health team for treatment.

Learning points

  • Young patients with capacity have the same rights to confidentiality as adults but it is usually in their best interests to involve their parents if the patient consents.
  • Disclosures may be made in the public interest if there is a risk of serious harm to the patient or others which outweighs their right to confidentiality.
  • Decisions about the best interests of young patients are often best made with others. If you are not sure whether to raise concerns about a young patient, seek advice from the local child protection lead or an experienced colleague with appropriate expertise.
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This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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