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Confidentiality

Confidentiality . Johnny.

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Confidentiality

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  1. Confidentiality Johnny

  2. Hi guys, I just put this slide in, just in case anybody does use this.The first 2 slides and the last 1 have information on them. Then the middle slides are a lot of practice examples. Some of these are really difficult (i.e. adapted from a 4th years SJT practice book) – they’re more for you to challenge yourself with. • Even if you find yourself struggling you’ll be able to use common sense to get an answer. • Learn your pink. Its seriously easy marks.

  3. When can you break it? • When given permission • When its in the public interest – Non-disclosure puts others at risk. Risk must be real, immediate and serious • Statutory duty to disclose: • Criminal activity • Births and Deaths • Infectious disease control • Driving • Child Abuse • Abortions

  4. 32-year old man, presents with severe fever, chills, productive cough and muscle aches. Recent travel history to Philadelphia. You suspect Legionnaire’s Disease • A notifiable disease. However at this stage it is only a suspicion. • So, no.

  5. 20-year old student, known to be sexually active, measures positive for HIV on a routine check. Follow-up investigations confirm the diagnosis of HIV • No. • HIV is not a notifiable disease.

  6. During a follow-up appointment: Whilst giving the patient information about safe sex, he admits he doesn’t use a condom, and he hasn’t told his girlfriend he is HIV+ • Once the patient is aware of his diagnosis, he is criminally liable for transmission. • In this case, the GMC states you can disclose to the partner without consent • The patient’s girlfriend is at risk of serious infection

  7. After becoming a Doctor (congrats.) you’re working on the stroke ward, you discharge one of your patients and advise her she shouldn’t drive for a little while. However, she disagrees with you, and when you see her a week later she informs you she has been driving Strokes do not require formal notification to the DVLA. What should you do instead? Ask them to get a second opinion What if they keep ignoring you? Then you should notify the DVLA, after telling the patient what you’re going to do Strokes/TIA, ACS don’t require formal notification to the DVLA (just advice about a period off driving) Things that do require notification: epilepsy/seizures, diabetes mellitus, acute psychosis, alcohol/drug abuse

  8. One of your patients, a 14-year old girl, is diagnosed with cancer. You first break this news to the parents, who inform you that they do not want her to know. What do you do? • You should explain to them that you should assess the capacity of the child and deliver information in a way they can understand. (Children and young people usually want to know about their illnesses. • You shouldn’t withold information unless the patient refuses knowledge of that information • Give me some exceptions: • The information would cause “serious harm” • The child specifically requests that someone else makes the decisions for them

  9. In GP-land: a 15-year-old girl visits you asking for contraception. Do you tell her parents? • In this case, realistically –no. • Its all about the patients competency. • Think Gillick-Fraser guidelines • These are all about trying to identify abuse btw.

  10. In GP-land: a 15-year-old girl visits you asking for contraception. However, she is visiting with her 35-year-old partner Do you tell her social services? • In this case, realistically –yes. • The GMC says you should consider sharing information are where: a big difference in age is ringing alarm bells

  11. In GP-land: a 17-year-old girl visits you asking for contraception. However, she is visiting with her 21-year-old partner, her art teacher Do you tell social services? • In this case, realistically –yes. • The GMC says you should consider sharing information when: The partner is in a position of trust • The full list where the GMC says you should consider sharing information: • The young person is too immature to understand • The child is under 13 • A big difference in age is ringing alarm bells • The partner is in a position of trust • There is a force/threat suggesting emotional,psychological or physical pressure • Drugs/Alcohol are involved

  12. For a Bonus Point: Where is most Dr-Patient confidentiality breached? • In a lift • In the canteen • In A+E departments • Through leaving patients notes open • In pubs and restaurants

  13. Capacity • To have capacity the patient must be able to do all of the following: • Understand the information relevant to the decision • Retain the information • Use the information as part of the decision making process • Communicate their decision

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