Confidentiality

Confidentiality • Dr Katherine Teare • GP 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 Confidentiality • Patients 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

Disclosures • Inform 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 situations • release 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

DVLA • can 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 wound • Disclose 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

Confidentiality