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. In short, 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
Why is it 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.
What is the practical application of the duty of confidentiality?
Consider the following scenario: you are a GP, and 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.
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. Clearly, 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.
What might I be asked about confidentiality?
What is confidentiality?
Why is confidentiality important?
Can you tell me a scenario where the duty of confidentiality would not apply, and why?
You may also be asked to discuss specific scenarios – remember the three considerations mentioned. There are more scenarios available from the GMC which should help to give you an idea of how the duty of confidentiality is applied in practice.
Words: Mariam Al-Attar
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