A case is described of a forty year old single man who made incriminating admissions about multiple perverse sexual practices during a psychiatric assessment including exhibiting in public places and putting a four year old girl's hand in his trousers for sexual stimulation. In common practice with other professional men, a doctor is under a duty not to disclose, without the consent of his patient, information which he has gained in his professional capacity other than in exceptional circumstances. When groups of adolescent and adult patients were asked whether they would seek medical care or divulge personal information without a promise of confidentiality, many said no. We discuss issues of medical confidentiality and the dilemma that sometimes face clinicians, when they feel obliged, in the public interest, to disclose information they have gained in confidence. Breach of confidences can have deleterious consequences; particularly for the doctor–patient relationship and failure to disclose in some situations could have serious implications for the well-being of the wider society. We draw comparison from cases in several jurisdictions and conclude that all doctors should be aware of the basic principles of confidentiality and the legal framework around which they are built. Doctors should not hesitate to discuss problem areas with their legal advisors before decisions are made regarding disclosure.