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:
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 confidential 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 medical 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 serious harm if you do not.
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:
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.
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 and disclosing identifiable patient information 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.
You need to understand how you can apply the key ethics pillars when you think about confidentiality.
For autonomy, you should think about:
However, there may be reasons you can break patient 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:
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:
However, Doctors must always consider the impact of a situation on society as a whole. If a Doctor learns of information that will assist non-healthcare services (e.g. social services/DVLA/police) in protecting the public, it is their responsibility to disclose the confidential information if the patient refuses to.
You might be asked medical 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:
For model answers to these questions, check out our ethics question and answer guide.
You can also check out scenarios available from the GMC which should help you understand how the duty of confidentiality is applied in practice.
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