ConfidentialityConfidentialityDr Katherine TeareGP Educator FellowDr Katherine TeareGP Educator Fellow

Hippocrates

Whatsover things I see or hear concerning the lives of men, in my attendance of the sick, or even apart therefrom, which ought not to be noised abroad, I will keep silence thereon, counting such things as sacred secrets

GMC ConfidentialityPatients have right to expect information held in confidence

Considerations legal, ethical and towards interests of wider community

If in doubt seek advice of seniors, Caldicott guardian or professional/regulatory body

Confidentiality cont...Central to trust and doctor-patient relationship

information should be available to patients advising personal information may be used for audit and disclosed for sake of own care

confidentiality a duty but not absolute

When can you disclose?

if required by law

if patient consents - implicitly for sake of own care or expressly for other purposes

if justified by public interest

Releasing information

Try to anonymise if practicable

Endeavour to get patients express consent

Keep disclosure to minimum necessary

Keep up to date with legislation

Protecting information

Much information disclosure accidental

Take care to protect records

Do not release any identifiable information including online

DisclosuresInform patients where practicable

May disclose to Presiding officer of Court or Judge without express consent but not to a solicitor or police

Justified in medical emergency

Justified on occasion ‘in the public interest’ e.g. to protect patient or others

Implied Consent

Amongst other health care professionals in the team

Respect wishes of patient who wishes to contain information and exclude members of team

Patient without capacity

care patient first, respect patient dignity and privacy and support and encourage patient involvement

consider if temporary whether decision to disclose could wait til regains capacity

can disclose ‘essential’ information against wishes if lacks capacity

Disclosure after death

Duty of confidentiality continues

Can disclose to partner, close relative or friend information with regards to circumstances surrounding death if no reason to believe patient would have objected

Specific situationsrelease of information to DVLA

communicating information about infectious diseases

stabbings / gunshot wounds

disclosing information for insurance and employment

release of information for financial purposes

children

DVLAcan disclose in public interest without patient consent and in exceptional cases where consent withheld

seek advice of experienced colleague or DVLA medical adviser if unsure if fit to drive

can suggest second opinion

if continues - persuade patient to stop, but if not contact DVLA

Gunshot / Knife woundDisclose promptly, with consent if possible

Inform police quickly whenever person arrives with gunshot wound or knife injury, then decide if disclosure personal information is justified, unless blade injury due to self harm or accidental

Insurance etc

Be satisfied patient has sufficient info about scope, purpose and likely consequences disclosure

Need written consent, disclose factual information

Disclose only relevant information

Criticism in the press

might include inaccurate or misleading information

still have to respect confidentiality

seek advice defence body

0-18 years

Same duties of confidentiality apply

Keep disclosures to minimum necessary

Ask for consent before disclose

Case studies

1. 87year old man with dementia who continues to drive

2. 43 year old man with depression and alcoholism who has been arrested

References

www.gmc-uk.org/ethical_guidance/confidentiality.asp

References

www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp