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Published on 20th November 2018 by lauram

Medical School Interview Course – Delivered by Doctors

Patient Confidentiality


Maintaining confidentiality is both a legal and ethical responsibility of healthcare professionals. Generally speaking doctors may not disclose any patient information without the patient’s consent.

However, confidentiality is not absolute and some situations will warrant breach of confidentiality. If patient confidentiality is likely to put human life at risk of harm, then as a doctor you must weigh up the pros and cons of breaking confidentiality.

As a doctor you should always consult the extensive guidelines on confidentiality available from the GMC before reaching you decision.

The best way to think through an ethical scenario is to consider the four principles of medical ethics. In a nutshell they are:

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For Patient Confidentiality:

  • Breaking confidentiality without the patient’s consent undermines the patient’s wishes. A patient-doctor relationship is built on trust.
  • Breaking this trust can shake the patient’s confidence in doctors. In the future the patient will be reluctant to seek help from healthcare professionals even if they desperately need it.  Therefore, respecting autonomy is essential.
  • If the patient is a child who is Gillick competent, their autonomy should be respected the same as an adult.

Against Patient Confidentiality:

  • Autonomy is reserved for patients who are competent and whose choices do not put others or themselves at risk.
  • This means that in some cases autonomy can be nullified.  An example of this is if the patient has told you that they have participated in serious illegal activity or that they intend to hurt someone.

How much do you know about medical ethics? Take the quiz>>

Beneficence and Non-Maleficence

For Patient Confidentiality:

  • The doctor’s priority should be their patient’s health and wellbeing. Occasionally breaking confidentiality means that the patient will get into trouble (e.g. with the police or their parents if it’s a child). Maintaining confidentiality will prevent them causing preventable distress to their patient.
  • A doctor should always advise patients to tell the appropriate people of their situation. If the patient does not the doctor should try to gain the patient’s consent before breaking confidentiality. This means patients will feel more content with the decisions being made around them.

Against Patient Confidentiality:

  • Sometimes patients do not comprehend the consequences of keeping information secret and they will often have a biased view. But as a doctor your views will be impartial and your main aim will be to do what is best for your patient.
  • Doctors will only breach confidentiality if it is in the best interests of those involved. In some cases, it will allow the patient to get the extra support that they need whilst in others it will prevent harm coming to the patient, their relatives or the general public.

Read our guide to medical ethics>>


For Patient Confidentiality:

  • The public’s perception of healthcare professionals can be tarnished if doctors are seen to disregard the importance of confidentiality.
  • This may lead to patients withholding information from their doctors as they worry who this information may be passed on to. Therefore, it is incredibly important for doctors to think carefully before breaking confidentiality.

Against Patient Confidentiality:

  • It is a doctor’s duty to always consider the impact of a situation on society as a whole. If a doctor finds out information which will assist non-healthcare services (e.g. police/social services/DVLA) in protecting the public then it is their responsibility to disclose it if the patient has adamantly refused to.

Read NHS Hot Topics 2018-19>>

What are some examples of ethical scenarios involving confidentiality?

You are a junior doctor. One of the patients on your ward has just been diagnosed with HIV. They tell you that they do not intend on telling their partner of this diagnosis. How would you deal with this situation?

A young first-time mum confides in you that she is struggling to cope with the baby and that she often has thoughts of harming the baby. She has asked you to promise not to tell anyone else. How would you deal with this situation? Explain your reasoning.

A patient with newly diagnosed, uncontrolled epilepsy tells you that he has a new job as a van driver. He has not notified his employers or DVLA that he has epilepsy. He tells you that if he loses this job he will be not be able to afford his rent and risks becoming homeless. How would you deal with this situation? Explain your reasoning.

Words: Ateka Gomaa

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