Confidentiality

Question 1

What 2 types of guidance are available for confidentiality?

Answer 1

1. GMC

2. Department of health ‘NHS code of practice’

Question 2

What is confidentiality?

Answer 2

A duty of confidentiality arises when one person discloses information to another in circumstances where it is reasonable to expect the information will be held in confidence; requires not sharing personal information deliberately/accidentally if expected not to

Question 3

How could doctors accidentally breach confidentiality?

Answer 3

• Bad record keeping i.e. losing information
• Talking about patients around hospital
• Details visible on paper when walking around the hospital

Question 4

What legal considerations have to be taken into account when considering use and disclosure of confidential personal health information?

Answer 4

Common law of confidentiality
Data protection act 2018
Human rights act 1998
Administrative law

Question 5

Why is confidentiality important?

Answer 5

• Fundamental to good doctor-patient relationship & thus, good care
• Patient’s trust in doctors & profession/health system
• Reputation of health system
• Allows patients to be more honest so we can diagnose & care for them better
• Keep patient’s safe e.g. if in vulnerable relationships

Question 6

What are the ethical concepts underpinning confidentiality?

Answer 6

Autonomy
Privacy
Identity
Promise keeping/dishonesty/trust

Question 7

How does confidentiality benefit patients?

Answer 7

• Encourages them to seek medical treatment
• Good for individuals & society at large
• Confidential medical service is in public interest

Question 8

Can maintaining confidentiality potentially harm people?

Answer 8

Maintaining absolute confidentiality may expose specific people to risk of harm AND/OR be contrary to the public interest in some situations

Question 9

Is confidentiality an absolute duty?

Answer 9

It is important but it is not an absolute duty but still must share the minimum information when required to breach confidentiality

Question 10

When can personal information be disclosed?

Answer 10

1. Patient consents
2. Required by law
3. Justified in public interest

Question 11

When might you disclose a patients information with their consent?

Answer 11

• For the purposes of patients healthcare
• Clinical audit
• Employers, insurers & government department

Question 12

When might you disclose a patients information as a legal requirement?

Answer 12

• Notification of certain infectious diseases
• At request of certain regulatory bodies
• If ordered by a judge

Question 13

When might you disclose a patient’s information if it is justified by the public interest?

Answer 13

• Gunshot & knife wounds
• DVLA
• Education/research

Question 14

When disclosing information with the patient’s consent, how would you go about this?

Answer 14

Disclose information in a way that conflicts as few ethical principles as possible

Obtaining consent respects patient autonomy & preserves good Dr-patient relationship

Question 15

What would be defined as routine disclosure of information with implied consent?

Answer 15

Sharing information within healthcare teams (including administrative staff) as its often necessary to provide care (information about this MUST be available to patients)

Patients generally understand & accept this so non-objection is taken as implied consent

Question 16

When might a patient object to routine disclosure of information within the healthcare team? Do you have to abide by there wishes?

Answer 16

In relation to particularly sensitive information e.g. HIV diagnosis

Objection must be respected but may have to inform patient that required treatment is not a possibility if information is not shared

Question 17

What organisations can ask for medical information disclosure? Why might they do this?

Answer 17

• Insurance companies e.g. personal injury claims
• Employers: check fitness for job
• Government agencies e.g. benefit claims

Question 18

When can you disclosure medical information to a third party organisation?

Answer 18

With informed consent of patient:

• Be satisfied that patient is sufficiently informed about what you are disclosing
• Only disclose relevant & minimal information
• Offer to show patient a copy of information before sent (if possible)

Question 19

When can you disclose medical information in the public interest?

Answer 19

If the benefits to an individual or society outweigh both the public & the patient’s interest in keeping it confidential i.e. weighs up harms of disclosure vs non-disclosure (can be hard to prove)

Question 20

What are the policies in terms of patient consent and public interest disclosures?

Answer 20

May not require consent although it should still be sought in some cases

BUT disclosure can be made even if consent is withheld

Question 21

What considerations must you take into account when disclosing information in public interest?

Answer 21

Does the information have to identify the patient? Could it be anonymised & still serve its purpose?

Compromises of privacy & autonomy should be kept to a minimum but has to be balanced against likelihood of preventing serious harm

Question 22

When disclosing information in the public interest, what must be made clear?

Answer 22

That the disclosure can protect individuals or society from risks of serious harm i.e. why disclosure is likely to be helpful

Question 23

What would you do if a patient has come in with a gunshot or knife wound?

Answer 23

Police must be informed as it enables them to assess risk to patient, staff & others

BUT personal information should not be disclosed in the initial notification usually

If police want identifiable details & patient does not consent, a decision must be made as to whether disclosure is in public interest -> if you decide against it, police may seek an order from a judge or warrant

Question 24

Why might the DVLA need to access a person’s medical information?

Answer 24

Legal responsibility for deciding whether a person is medically unfit to drive

Provides guidance on disorders & conditions that may affect ability to drive

Question 25

What would you do if your patient’s condition or treatment may make them potentially unfit to drive?

Answer 25

Explain to them that there condition may impact on driving & inform them of legal duty to inform the DVLA

If they continue to drive, make reasonable effort to persuade them to stop (talk to relatives/friends/carers)

If patient cannot be persuaded, must contact DVLA & disclose relevant information to medical advisor; notify patient of intention to do this & confirm in writing when done

Question 26

Should you inform the patient’s GP of a serious communicable disease e.g. HIV if they do not give consent?

Answer 26

Patient should be encouraged to consent as this will benefit care

If they refuse consent, decision must be respected as no risk of infection to medical staff if standard infection control procedures are followed

Question 27

Should you inform the patient’s partner of a serious communicable disease e.g. HIV if they do not give consent?

Answer 27

Patient should be encouraged to inform partner

If they refuse, you can disclose the information to a known sexual contact of patient as they are at risk of infection & harm; patient should be informed of disclosure in advance if safe to do so

Question 28

Should confidentiality policies & procedures be followed for medical students?

Answer 28

Yes