Interview - AMA Vice President, Dr Mukesh Haikerwal, with Kevin Naughton, Radio ABC 891 Adelaide 'Drive' - Childrens access to Medicare cards

NAUGHTON:       Here's a question that has a couple of elements to it, and will resonate with a couple of parents, I think:  should young people have their own independent Medicare card, separate from their family's card.  And therefore, should their medical records be kept private, and not accessible by their parents?  And at what age is that shift of responsibility appropriate?

Apparently at the moment, children must be 15 to get a Medicare card without parental consent, but children of any age - any age at all - can get a Medicare card, providing they've got their parents' approval.

Now, once they've got it, that's it - the parent can't get access to the medical records, we understand, without the child's consent. 

Now, there's probably pluses and - or pros and cons for all this.  And you might have some thoughts on it.  A few groups have got involved in recent times - the Health Insurance Commission has recently ruled that children aged 14 and over must give consent before their parents can access their Medicare records.  The Prime Minister reckons that age should be 16.  The AMA's had a bit to say about it as well.  And the Vice-President of the Australian Medical Association, Mukesh Haikerwal, is our guest this afternoon. 

Welcome to you.

HAIKERWAL:      Hi, Justin.  Thank you.

NAUGHTON:       Now, what's the background to this in terms of why there's even consideration of a change to the age?

HAIKERWAL:      My understanding is that there's been some pressure from the Coalition backbench into this issue, since the privacy legislation, which we've all had introduced across the country, seems to have been getting a bit out of hand.

I understand there's been some discussion at Cabinet level to approve this change, and you know, I can understand the concerns around the privacy issue, but I think that this particular change that's being mooted is not going to be in anybody's interests, really.

You know, I think that - with the best will in the world we always try and suggest to people that if they want some medical treatment, and they're underage, they should really be talking with their parents or a responsible adult.  But sometimes that just isn't possible, and people, whatever age they are, should have the confidence that their details will be kept totally confidential, and not revealed to anyone, whether it's the HIC revealing it, and certainly the doctor won't be revealing it.

NAUGHTON:       Under what circumstance would a child who is, say, 14 or 15, want to keep their medical records away from their parents?

HAIKERWAL:      Look, I mean, I think that, you know, with the best will in the world, many of our laws are not adhered to - that people younger than 16 will be involved in, you know, sexual liaisons, some of them will be using drugs, some of them will be having problems with depression.  Some will be being bullied, or you know, having sexual or physical abuse.

And all these sorts of things are things that they may not want to necessarily talk with their families about, but of course we'd be trying to persuade them to do so, but if they weren't, they still need those problems dealt with.

And it needs to be dealt with in a safe setting, in a confidential setting, and in a setting where they know that they can reveal exactly what's going on in their minds and their heart so that it can be dealt with.

NAUGHTON:       Now, what if the current situation, Mukesh, when a family has a Medicare card, you know, and let's take the ordinary average suburban possibilities - father, mother, two children, all on the one Medicare card.  What's the process where a family member would separate themselves from that card?

HAIKERWAL:      Well, I mean, I think that if a child - a young person, we should really say is moving away, going on a camp for some time, or going off to a boarding school or whatever, that may be an opportunity, and in the run of the mill, you know, parents are saying yep, no problems, we'll organise a card for you.

When families split there'll often be two Medicare cards, one for each member of the previous family unit, and the child will be on both cards.  And that can be a bit confusing from time to time.  And sometimes the child themselves would like to have access to a card so that the can get advice from whichever practitioner that they're wanting to go and see, whoever they're closest to at the time.

NAUGHTON:       Now, once they get their own card, what are a parent's rights in respect of that child's medical records?

HAIKERWAL:      Well, again at every opportunity we would suggest that children - the young people should actually be, you know, getting their parents, or their responsible adult involved in their own needs and their health needs, and available to be there for discussion.

If that's not possible, then obviously they should be able to have that consult with their doctor in the knowledge that that would be confidential.  The parents really don't have any access to the medical records of the child in that situation.

What the situation regarding Medicare is that if they raise the age to 16 where Medicare information is obtainable, Medicare now has an awful lot of information there about not just who the person's been seeing, or the type of doctor they've been seeing or the type of service they've been getting. 

There are also some diagnostic groups ...... so asthma, diabetes, mental health - items that are actually out there, so you can immediately glean from getting what could be seen as bland bits of information and numbers, you can actually get that sort of detail from the Medicare data.

So it's not just a lot of figures that mean nothing.  It's a very sensitive set of information that really needs to be kept confidential, and if the young person doesn't want anybody to know about it, nobody else should know about it.

NAUGHTON:       Are there situations where a doctor might think that it would be in the best interest of the patient - i.e. the child - for the parents to be informed?  And in that situation I'm assuming that because of these privacy laws, that the doctor can't act in that direction?  Is that right?

HAIKERWAL:      Well, this is the case with the privacy legislation.  Certainly, I mean, we talk about in general cases first, you know, if you want to talk to about your parents, for instance, you can certainly do that, but you can't get information the other way.

And you need to make a note about the fact that where this information's come from, so your informant, who's acting in the best interests of say a person with dementia for instance, may find themselves under scrutiny.

Now, in the case of a young person, of course, if we believe that the young person would, you know, is not mature enough to make the decision on their own, they should certainly have access - and we would be very strongly encouraging them to speak with their parents about their situation, and if not certainly a responsible adult.

And sometimes, because it's necessary to involve some of the  Department of Health authorities, so at least they're kept safe if they're in a position of danger, and certainly that they are given some form of additional help from people in the know who are in a position of authority who can guide them as well.

So you have a youth worker, a social worker, as well as their own GP as well as other responsible adults around their school environment.  But best of all, of course, is to try and get the parents involved.  That's always the first line.  But sometimes they just - it's just an impossibility.

NAUGHTON:       It's just not a reality.  Yes.  We're looking at the question of whether young people should have their own independent Medicare card, and if so from what age?

Now, the AMA's position, Mukesh, is that from the age of 15 you think that's a reasonable age for a child to have these privacy rights.  Why did you choose 15? 

HAIKERWAL:      Well, 15 seemed to be a relatively good compromise.  I mean, at 15 people are already making independent decisions about what they're doing with their lives - with their love life, with their, you know, their other sorts of activities.

And they're already leaving school and setting up in work and so on, and they're given a certain level of responsibility.  And, of course, people's maturity is not necessarily the same as their actual age, and sometimes younger folk can feel more confident, and be able to make decisions, and older kids are actually less able to.

So there is some decision around, you know, whether somebody's actually competent to do this sort of decision-making or not.  But 15 seems to be a reasonable age of cut-off, where you can say look, at this age these people will be making their own way, paying their taxes, and making life - and leaving school and so on.

We understand that the age of consent for certain activities is 16.  But that doesn't make any difference.  Those people are still active under that age, and we want to make sure that they get the best advice, that they're kept out of harm's way, and that they take all the right precautions, and have all the right information at their fingertips so that they can make the best decisions.  Obviously with their parents involved, if possible.  Obviously with an adult with some maturity.  But sometimes they are on their own, and they need to have confidence that they can talk at leisure and talk in confidence with their health provider - with their doctor.

NAUGHTON:       And, no doubt, there will be situations where a parent feels aggrieved or frustrated by this process.  What options are open to them?

HAIKERWAL:      Yeah, look, obviously there are - I mean, we had a case in our practice last week where a mother of a 19 year old got upset with the fact that  she was requested to perhaps allow the discussion to be without her being present.  So, you know, that can happen at any age.  If there's a grievance, I mean, the answer is that it needs to be discussed.  The parent needs to discuss that with the medical practitioner, the parent needs to, in terms of whom to go to - there's the privacy commissioners, State and Federal, can advise as to what the legislation says.  And then there are the health services commissioners and people like that who can also give advice.

Ultimately, it's a decision between the young person and the parent as to whether the information is given up or not, and it says more about the relationship between the parent and their younger - the person that they're caring for - if they can't actually get out and do that.

And, of course, unfortunately that is the case, sometimes, where they can't get that commitment.  They can't get that good relationship.  And therefore, you know, the material may not be available to them.

NAUGHTON:       Mm. Sometimes a GP ends up as the meat in the sandwich, too.

HAIKERWAL:      That's right.

NAUGHTON:       Mukesh, thank you very much.

HAIKERWAL:      You're very welcome. Thanks for the opportunity.

NAUGHTON:       Mukesh Haikerwal, Vice-President of the AMA.  It'd be a difficult situation, wouldn't it?  If you're a parent and a child said no, I don't want you to be involved in this.  That would be very, very difficult, I would think.  Must, you would assume, point to some issues or problems in the relationship between parent and child. I'd hate to be in that situation.

Ends