In France, medical confidentiality is the golden rule. Yet, “the presence of a loved one in consultation is almost never legally essential, but it is largely possible and supervised”
first of all recalls Dr Gérald Kierzek. In reality, it is the patient’s will that dictates the rules of the game. Here they are.
The trusted person and the announcement of serious diagnoses
The strongest system remains that of the trusted person. Any adult can designate, ideally in writing, a loved one who will support them in their care journey.
In fact, this individual will have a supporting role. “This person can attend interviews and help you digest complex information” explains our expert. But not only that. “In the event of a hard blow, when a serious diagnosis or prognosis is made, the law allows relatives to be informed to organize the necessary support, unless the patient objects.“.
In these moments of vulnerability, the loved one becomes the essential relay of medical information to prevent the patient from finding themselves alone with the news.
Minors and adolescents: between protection and privacy
For children and adolescents, the rule is that of support by those with parental authority. The doctor cannot arbitrarily dismiss a parent.
However, modern medical practice qualifies this presence.
“One-on-one is sometimes essential” recalls Dr. Kierzek. “With a teenager, the doctor often offers alone time and this is recommended to encourage useful confidences.”
The right to secrecy is also recognized. If a minor wants essential care (contraception, STIs, etc.) but refuses to let his parents know, he can request secrecy. In this specific case, he must be accompanied by an adult of his choice to validate the process.
Disability, vulnerability and language barrier
In certain situations, the loved one becomes “the voice” or “the memory” of the patient. This is the case for people suffering from cognitive disabilities or comprehension disorders (Alzheimer’s disease, for example).
The caregiver then has a crucial presence for adherence to treatment and monitoring at home. The doctor must, however, be careful to “address the patient himself first” to respect his dignity.
In the event of a language barrier, the loved one can serve as an interpreter. However, the medical profession often prefers a professional. For what ? To avoid things left unsaid related to modesty or possible conflicts of interest. The doctor can then “offer time alone for certain sensitive subjects”
that the patient would not dare to discuss in front of his family.
Medical confidentiality: who decides what?
It is crucial to remember that medical confidentiality protects the patient, even against their own family. “No information can be shared with a loved one without their consent.“, emphasizes Dr. Kierzek. Whether it’s what is said in the office or what is seen during the examination.
If he gives his agreement, in the majority of cases, the oral form is sufficient. In addition, the patient can change companions from one session to another.
Finally, the practitioner can ask the loved one to go out for a moment, particularly for an intimate clinical examination or if he suspects external pressure.
“As the legal framework reminds us, medical confidentiality can never be a pretext for excluding a loved one that the patient wishes to have at their side, but the latter’s freedom of speech remains the absolute priority. concludes our expert.