Confidentiality Flashcards
When is it acceptable to disclose personal information about a patient?
1) the patient consents - either implicitly for the sake of their own care or a local clinical audit, or explicitly for other purposes
2) if the disclosure is of overall benefit to a patient who lacks capacity to consent
3) if the disclosure is required by law
4) if the disclosure is justified in the public interest (i.e. an infectious disease)
What are some examples of where breaching patient confidentiality is appropriate?
- Sharing information with other healthcare professionals involved in the care of the patient e.g. sending a discharge summary to a GP, sending a referral letter to a specialist doctor (implied consent)
- Using information for the purpose of clinical audit (implied consent)
- Disclosures required by law/court order (e.g. infectious diseases)
- Disclosing to a statutory regulatory body (when investigating FTP, information about specific pt cases may be required). If the pt refuses, need to discuss the situation with the GMC.
- Disclosure is justified in the interest of the public (e.g. HIV patients knowingly infecting others, an epileptic driver despite advice from the DVLA).
- Treatment of children or incompetent adults (i.e. a child comes to see you, is not competent to make a decision, but is asking you to keep their visit confidential. Need to first negotiate with them and encourage them to involve the appropriate person then if they refuse you may need to involve an appropriate person if the treatment is essential and in their best interests. The pt should be aware of your intentions at all times).
- Abuse or neglect of an incompetent person (child/elderly). If disclosure is in the best interest of the pt then you should do so. If you decide not to report, must be able to justify the decision.
How do you involve the patient in matters of breaching confidentiality?
Whenever you need to breach confidentiality, you should always discuss it with the patient beforehand, obtain their consent and inform them of your plan.
In disclosures required by law, you should make every effort to inform the patient, but their refusal cannot discharge you from your legal obligations.
In terms of clinical audits, you must inform them that their data may be used internally for an audit. This is implied consent as you’re not actually asking them, but informing them and allowing them to object. If they do object you must respect this. If data is being given to an external organisation it must be anonymised. Patients need to be informed which personal details are being held for audit or research purposes.
In terms of communicating between healthcare professionals involved in a patient’s care, you must ensure the patient understands that such disclosures are made, and if they object to the disclosure, you must take every possible step to comply with their wishes.
When is it ok to disclose information for the protection of others without a patient’s consent?
You should ask for a patient’s consent to disclose information for the protection of others unless the information is required by law or it is not safe, appropriate or practicable to do so. You should consider
any reasons given for refusal.
What can you do if someone does not give consent that is in the interest of the public?
If it is not practicable or appropriate to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the
patient’s and the public interest in keeping the information confidential.
Before deciding whether disclosure would be justified in the public interest you should consider whether it is practicable or appropriate to seek consent. You should not ask for consent if you have already decided
to disclose information in the public interest but you should tell the patient about your intention to disclose personal information, unless it is not safe or practicable to do so. If the patient objects to the disclosure you
should consider any reasons they give for objecting.
Who is responsible for telling the DVLA about a condition/treatment that impairs their ability to drive?
The driver is legally responsible for telling the DVLA about any such condition or treatment.
Doctors should therefore alert patients to conditions and treatments that
might affect their ability to drive and remind them of their duty to tell the appropriate agency.
Doctors may, however, need to make
a decision about whether to disclose relevant information without consent to the DVLA in the public interest if a patient is unfit to drive but continues to do so.
If a patient is incapable of understanding this advice – for example, because of dementia –
you should inform the DVLA as soon as practicable.
How do you assess a patient’s fitness to drive?
When diagnosing a patient’s condition, or providing or arranging treatment, you should consider whether the condition or treatment may affect their ability to drive safely.
You should:
- refer to the DVLA’s guidance Assessing fitness to drive – a guide for medical professionals, which includes information about disorders
and conditions that can impair a patient’s fitness to drive
- seek the advice of an experienced colleague or the DVLA’s medical adviser if you are not sure whether a condition or treatment might affect a patient’s fitness to drive.
What do you do if a patient refuses to accept their diagnosis or the effect of their condition on their ability to drive?
Suggest that they seek a second opinion, and help arrange for them to do so. You should advise the patient not to drive in the meantime. As long as the patient agrees, you may discuss your concerns with their relatives, friends or carers.
If you become aware that a patient is
continuing to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop. If you do not manage to persuade the patient to stop driving, or you
discover that they are continuing to drive against your advice, you should consider whether the patient’s refusal to stop driving leaves others exposed to a risk of death or serious harm. If
you believe that it does, you should contact the DVLA promptly and disclose any relevant medical information, in confidence, to the medical adviser.
Before contacting the DVLA, you should
try to inform the patient of your intention to disclose personal information. If the patient objects to the disclosure, you should consider any reasons they give for objecting. If you decide to contact the DVLA, you should tell your patient in writing once you have done so, and make a note on the patient’s record.
