Confidentiality Flashcards
Disclosing information to protect that patient:
Adult
Does the patient have capacity?
If yes - they have a right to make an unwise decision.
If no - you have to act in their best interests.
Child
GMC guidance - if any concerns about welfare of child, seek consent if appropriate but report to relevant agencies promptly.
Scenario 1:
An elderly woman attends A&E with extensive bruising. She is physically frail but mentally alert.
She tells the doctor that her daughter did this to her.
The doctor wants to call the police or contact social services to make a safeguarding referral.
She says she doesn’t want to get her daughter in trouble.
Can the doctor breach her confidentiality?
Doctors should provide patients with information and support to make decisions in their own interests, e.g. Agencies that support victims of elder abuse.
GMC para 57-59: It may be inappropriate to encourage patients to consent to disclosures you consider necessary for their protection, and warn them of the risks of refusing consent, even if their decision leaves them, but nobody else, at risk of serious harm.
So doctors should usually abide by a competent adult patient’s refusal to consent to disclosure.
Therefore, in this scenario, the doctor cannot call the police.
The situation may be different if a child was living with the patient.
Disclosing information to protect others:
GMC guidance on “public interest” - Reporting concerns about patients to the DVLA - April 2017.
Reporting gunshot and knife wounds - April 2017.
Scenario 2 - DVLA:
Patient with epilepsy advised not to drive by neurologist.
Three weeks later, the neurologist sees the patient driving away from another hospital appointment.
What should the neurologist do?
Can and should the neurologist inform the DVLA?
Decision:
The DVLA are responsible for determining if a person is medically unfit to drive.
Driver is legally responsible for informing DVLA of such a condition.
Explain to the patient that condition may affect ability to drive and they then have a legal duty to inform DVLA.
You should make reasonable effort to persuade them to stop driving.
If you cannot persuade patient to notify DVLA or you discover they are continuing to drive, contact medical advisor at DVLA in confidence.
You should inform patient of this.
Scenario 3 - request from a colleague:
One of your colleagues has gone on holiday and his father, who has become ill, has just ben admitted in your hospital.
Your colleague phones you from his holiday and asks if you can find out more about what is happening with his father.
Can the patient consent to disclosure of this information?
Discuss the request with the patient’s treating clinician.
Is your colleague listed as ‘next of kin’.
If permissible to disclose information, consider the extent of disclosure.
Document steps taken and enquiries in medical records.
Scenario 4 - a mother’s right to know:
14-year-old patient attends GP appointment unaccompanied.
Mother later finds out inadvertently about the appointment and demands to see the notes
What should the GP do? Is the mother entitles to see the notes?
Gillick competence comes in here
Decision:
Is the child Gillick competent?
Be aware as children grow older and become competent, they also become entitles to confidentiality about that treatment.
Scenario 5 - knife wounds:
A&E - 2 patients at different times of the evening arrive with stab wounds.
Both patients report having been attacked in a similar manner and the assailant seems to be the same person.
One of the patients is happy to speak to the police - the other is not and leaves before the police are called.
Should the staff report both incidents to the police?
Should the identity of the patients and the details of their injuries be reported?
Reporting of knife cries is in the public interest.
A knife attack may justify a public interest disclosure of confidential information without consent.
For the first patient, the police could be called to interview them, They would be expected to identify themselves; describe their attacker and their injuries.
If the patient recused to provide some of those details, the hospital could.
For the second patient, it is likely to be proportionate to provide the police the same amount of information that they’ve given about the first patient.
Scenario 6 - an estranged father’s right to receive info:
Medical secretary receives request over the telephone from a father asking for copy letters that have only gone to mother where child’s parents are not together.
You saw child (aged 11) in clinic with mother. It does not appear that the split was amicable.
Secretary asks you for advice.
Decision:
Did the father have parental responsibility?
If yes, entitles to information.
Inform mother that you will be sharing information.
Remember, situation could be different if the child was older and considered Gillick competent?
Scenario 7 - disclosures to the police:
You are working in the Minor Injuries Unit where you treat a young man with several cuts on his hands. The man claims that he was washing a glass at home and accidentally shattered it, injuring himself. You believe that the pattern of cuts is unlikely to have been caused by that mechanism of injury, but the patient sticks to his story.
Later that day, a police office comes to the ED enquiring about any men who may have attended with cuts to the hands. A young man had broken into an empty property through a glass window and stolen some goods. There were no victims and no suggestion of threat to public safety.
What should you do?
Decision:
Seek a Senior review from your Consultant.
Your starting point is your duty of confidentiality to your patient.
Is there any risk to the general public.
You can breach confidentiality if it can assist in detecting and preventing serious crime, including crimes that cause serious physical or psychological harm to individuals.
Advised not to alert the police in this scenario.
Scenario 8 - road traffic accident (RTA):
A GP approached by the police asking if she could identify a driver from a CCTV photograph. The driver had apparently, seconds after the photo was taken, been involved in an incident in which a pedestrian was injured after the car emerged from the surgery car park. Witnesses at the scene had reported that the driver was driving recklessly.
The police said that they urgently needed information to identify the driver. The GP recognises the driver as one of her patients and wonders whether she should give his name and address to the police.
Decision:
Under the Road Traffic Act 1988, there is a legal requirement to disclose information to the police to allow them to identify a driver who has allegedly committed a road traffic offence.
Is a criminal offence to fail to comply with such a police requirement.
GP should provide name and address of patient.
Make a note in the patients records as to whether, what and why information has been provided.
Scenario 9 - child at risk:
A neurologist recently sees a patient he had been treating for headaches. The patient is very upset during the most recent consultation and says media coverage of historic child abuse has brought back memories of when he was abused as a child. He confesses that he has recently abused a 13year old friend of his daughters when she was having a sleepover at their house.
The patient asks the neurologist not to tell anyone as he would never do anything like that again.
Decision:
Would a failure to disclose this information expose others to a risk of death or serious harm?
Despite the patients reassurances, he has confessed to a serious crime and children may well be at risk.
Minimum information should be provided - just what is required and relevant.
Clearly document in the patient’s record the reasons for the disclosure; what information has been disclosed the steps taken to obtain patient consent or the reasons for not doing so.
