Confidentiality
ICL 2
Dr Ruth Bromley
MBchB MRCGP MA(Ethics)
Hippocratic Oath
‘Whatever in connection with my professional
practice, or not in connection with it, I see or
hear in the life of men, which ought not to be
spoken abroad, I will not divulge, as reckoning
that all such should be kept secret.’
Confidentiality
Why is it important?
• Doctor-patient relationship- ?special
• Nature & importance of the information
shared
• Demonstrates respect
• General duty & positive legal duty
• Article 8 of European Convention on Human
Rights
Beware
• On the ward- do curtains make others deaf?
• In the corridor
• In the canteen
• In the out-patient clinic
• In the GP surgery
• In the pub
Case 1
• A patient on ICU, who may or may not recover
from their illness, is found to be HIV positive.
The family have asked to be kept fully
informed. Should the patient’s HIV status be
discussed with the family?
Case 2
• A patient is brought to A&E unconscious. They
are accompanied by the police who inform
you that they suspect the patient of drunk-
driving. They request a blood alcohol level
whilst you are taking ‘routine’ tests and want
the result as soon as it becomes available.
What should you do?
Disclosures
• With pt’s consent- must do upmost to obtain
• Sharing info with healthcare team (beware
police & social services)
• Audit
• Emergency care
• Public interest outweighs patient’s interest
GMC 2004
It is particularly important to check that
patients understand what will be disclosed if
you need to share identifiable information
with anyone employed by another
organisation or agency who is contributing to
their care.
Any information shared should be done so in
confidence.
GMC 2004
Legalities (1)
• Courts will act to restrain disclosure of info
unless said information is in public interests
• Public interests in maintaining confidentiality
balanced against public interests of public
safety and danger ensuing if confidentiality is
not breeched
Legalities (2)
• Generally, courts will act to protect the
confidentiality of all adults with capacity who
refuse to have their information shared
Case 3
You are the F2 doctor on the paeds ward and
are meeting with the mother of a 14y girl. The
patient is not present. As your discussions of
her daughter’s current treatment come to an
end, the mother asks you to look through her
daughter’s drug record and tell you if she is
taking the oral contraceptive pill. What should
you do?
Children
• Gillick Competence
• Fraser Guidelines
• Capacity
• Right to refuse treatment
• Children’s Act 2005
Case 4
• You are a GP trainee. A patient has come for
the results of some swabs that show that he is
testing positive for gonorrhoea. Having
discussed the implications of this, he leaves
refusing to inform his wife of the results. She
is also your patient. What should you do?
Exceptions (1)
• Prevention of harm
• Communicable diseases- seek consent first
but not needed
• Compulsory disclosure (judge:court of law)
• Public Health Control of Disease Act 1984
eg cholera, plague, small pox, typhus
Exceptions (2)
• Accidents at work
• Food poisoning
• Abortion
• Births and deaths
• Misuse of drugs
Case 5
• A 96y old gentleman with severe dementia
attends A&E with their daughter. The patient
shows little evidence of understanding. Is it
acceptable to discuss their care with their
relatives?
Patient’s lacking capacity
• If temporary, good practice to share and to seek info
but disclosures should be kept to a minimum eg
emergency care
• If permanent, more open discussions seen as ‘best
practice’
• Beware, Mental Capacity Act 2005 (Section 4(7))
assumes capacity until proven otherwise
Practicalities
• Maintain Confidentiality unless good or
compulsory reason not to
• Unless immediate risk, make every effort to
obtain patient consent to release information
• Keep robust and contemporaneous notes
justifying your decision to breech
• If in doubt, seek senior or expert advice
Any questions?