Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Confidentiality

Dear Dr Margaret
I am 23, and on the contraceptive pill. My mother does not know that I am on it. Now I am to see my doctor about something she knows I have (food allergy) and she insists on coming to the doctor with me. I am worried my doctor will say something while my mother is present. She will go mad if she ever finds out. What can I do? Do I ring my doctor beforehand, and tell him not to say anything because my mother is coming with me?

My first thought on reading your message was that at 23 you are an adult woman, so how come your mother is able to ‘insist’ that she comes with you? Does she always insist on being present when you see a doctor? If so, you should establish your independence, at least as far as medical matters are concerned. She probably hasn’t quite realized that you are now grown up, so you could tell her firmly, but as nicely as possible, that in future you will see your doctor alone. It might be easiest to tell her this at a time when no medical consultation is imminent.

However, if your mother is in charge of the household meals, it might be sensible for her to hear what the doctor has to say about food allergy, instead of getting the information second-hand from you.

I think your suggestion of contacting the doctor beforehand is a good one. If you and your mother go together, your doctor would not know that the discussion has a no-go area. The professional codes of practice of doctors and nurses and other health professionals state that they have a duty not to disclose any information about individual patients to anyone without their consent (except in very exceptional circumstances). However, the fact that you have brought your mother with you suggests that you give consent to a discussion of your health in her presence. Food allergy is a broad topic, so your doctor might quite reasonably assume that all aspects of your health could be discussed. Actually, I think is very unlikely that the contraceptive pill would be relevant to the discussion, and most sensitive doctors would not mention sex-related topics in the presence of someone else.

Another way of dealing with the situation would be for you to visit your doctor alone beforehand, for a full discussion of food allergy. At that consultation, you could say that you would like your mother to come with you for a further consultation, and that you do not wish your contraception to be mentioned.

Everyone working with your doctor – not just doctors and nurses – has to keep information confidential. For example, in the UK, the Association of Medical Secretaries, Practice Managers, Administrators and Receptionists (AMSPAR) says its members are bound by the following rule: “Members will strictly observe and uphold the principles of confidentiality. Anything learned from a patient, a medical practitioner, patients’ records or correspondence must never be disclosed to an unauthorized person”.

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