Confidentiality is an ethical issue that might come up during your Med School interview. Make sure your interview prep includes researching this issue and learning how you can apply the four pillars of medical ethics to confidentiality.

What Is Confidentiality?

Confidentiality is one of the core duties of a Doctor towards their patients. This is set out by the General Medical Council’s document, Good Medical Practice, a document that guides Doctors’ ethical and legal decisions.

The duty of confidentiality requires Doctors, and other healthcare professionals, to keep their patients’ information private within the healthcare team, apart from some very specific circumstances. These circumstances include the following:

  • Where the patient has consented to the sharing of information
  • Where not sharing the patient’s information puts the patient, or others, in danger
  • Where the patient lacks capacity and sharing information is of overall benefit to the patient

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Why Is Confidentiality Important?

Ensuring the patient’s right to confidentiality is key to building trust in the Doctor-patient relationship.

It is proven that patients will under-report their symptoms, or even avoid seeking medical help if they think that their information will be disclosed without consent. This makes the Doctor’s job of caring for the patient much more difficult, to the detriment of the patient.

However, knowing the boundaries of confidentiality is also important, because not only is appropriate information sharing within the healthcare team needed for safe and effective care provision, but sometimes, you are required by law to break confidentiality if somebody will come to significant harm if you do not.

Confidentiality Scenario

Consider the following confidentiality scenario:

One of your patients is a consultant who works at the local hospital. He comes to see you and admits that he is having a lot of trouble at home. Because of this, he has started drinking alcohol very heavily and feels dependent on it. He insists that this is not impacting on his work, but you believe that it may be, due to the heavy level of drinking and the withdrawal symptoms he describes when has not had a drink. You contemplate informing the hospital about the consultant’s alcohol dependence.

What do you need to consider when making this decision?

The General Medical Council (GMC) recommends that the following considerations are made in this situation, before a possible breach in confidentiality:

  • Is it likely that anyone will be harmed as a result of the consultant’s drinking?
  • What impact will revealing this information without consent have on the consultant?
  • Is there anything else that can be done which does not involve a break in confidentiality?

These considerations can be applied to any situation. A patient’s right to confidentiality is assumed as a prerequisite to any consultation, but you should be on the lookout for factors that might affect this.

Furthermore, it is very important that you inform patients about what you are going to do. It may be that this convinces them to inform the relevant party themselves, which is always a preferable option.

What Is The Practical Application Of The Duty Of Confidentiality?

There are also situations where Doctors are tempted to break confidentiality for reasons other than those proposed to be acceptable by the GMC. This can include something as simple as wanting to vent about your frustrations to your friends or even wanting to publish a patient’s case in a journal. Individual situations should be analysed carefully.

Breaking confidentiality just to vent to your friends is not beneficial to the patient, nor does it prevent danger to someone else. This is therefore unacceptable, and alternative coping mechanisms are needed.

With regards to publishing care reports – this has far more potential to be acceptable, as publications benefit other clinicians and patients, but this completely relies on the patient’s consent.

Applying The Four Pillars of Ethics to Confidentiality

You need to understand how you can apply the key ethics pillars when you think about a patient’s confidentiality.

For autonomy, you should think about:

  • Breaking confidentiality without a patient’s consent breaks their autonomy
  • It also undermines trust and may cause patients to be reluctant to seek help from healthcare professionals in the future, even if they desperately need medical attention.
  • This applies to children, too. If a child is Gillick competent, their autonomy should be respected the same as an adult.

However, there may be reasons you can break confidentiality for reasons of autonomy. For example, if a patient has told you they’ve done something illegal or have intentions to hurt someone, you may be able to nullify autonomy.

When it comes to beneficence and non-maleficence, you need to consider:

  • How breaking confidentiality could put a patient at risk (with the police or their parents, for example) or cause avoidable distress
  • Whether you can advise a patient to tell the right people about their situation to avoid breaking confidentiality
  • If you can gain consent to break confidentiality

It’s also worth knowing that a breach of confidentiality can only occur when it is in the best interest of those involved. In some cases, it will allow patients to get the extra support they need, in other cases, it could prevent harm coming to the patient, their relatives or the general public.

When it comes to justice, keep in mind:

  • If confidentiality is continuously broken without justifiable reasons, the public perception of healthcare professionals will be tarnished.
  • Suspicions of healthcare professionals could mean patients purposefully withhold information in fears of who it will be passed on to.

However, Doctors must always consider the impact of a situation on society as a whole. If a Doctor learns of information which will assist non-healthcare services (e.g. social services/DVLA/police) in protecting the public, it is their responsibility to disclose the information if the patient refuses to.

Confidentiality Questions

You might be asked ethics questions about confidentiality in your interview – or it may be possible for you to bring in confidentiality when answering something more general in order to illustrate your knowledge.  For example, the topic that might feature could be:

  • What are the confidentiality issues involved in a patient diagnosed with HIV disclosing they have not told their partner?
  • In what sort of circumstances is a breach is confidentiality permitted?
  • An underage patient mentions they are sexually active but have not told their parents about it, what scenario would force you to break Doctor-patient confidentiality?

For the answer to these questions, check out our ethics question and answer guide.

You can also check out scenarios available from the GMC which should help to give you an idea of how the duty of confidentiality is applied in practice.

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