Confidentiality

Question 1

What is it?

Answer 1

Arises when one person shares information to another, expecting it will be held in condifence ( not spilled)

Requires not sharing information deliberatly or accidently if expected not to.

ex of accidents :

losing documents, talking about patients in halls, patient notes are visible, database seen by patients. ( you probably wont do it unwittingly)

Question 2

Describe the legal framework governing disclosure of patient information

Answer 2

–Common Law of Confidentiality

–Data Protection Act 2018

–Human Rights Act 1998

–Administrative Law

Question 3

What reasons does the GMC guidance state as to why conf. is important?

Answer 3

2 concepts - trust in the profession and autonomy

1. Trust is central to the patient, doctor relationship and confidentiality is central to this. Good patient doctor relationships are central for good care.

They trust wont disclose it to people they know or the public.

If this trust is broken..

Patients wont share information or under report symptoms = neg. impact on thier health and population = profession destroyed, population unhappy diseased .

2. If they think their personal information will be disclosed without consent, or without the chance to have some control over the timing or amount of information shared, they wont share.

Not allowing them to have a say about thier information breaches thier autonomy.

Question 4

Ethical Concepts Underpinning Confidentiality

Answer 4

PAPI

Autonomy – my information, my life, I’ll decide who it gets shared with.

Privacy - if we expect to remain private will generally remain private ( esp health info)

Identity - I would like to control how people see us. if information gets ut we dont want we feel less in control and lose our own sense of identity. anonomised

Promise keeping/dishonesty/trust - integrity, reduce reliabiltiy reduce trust in the profession.

Question 5

Identify situations when confidentiality may be breached and justifications for doing so

Identify situations of public interest where doctor is legally required to disclose

Answer 5

CLi ( silly)

1) Patient consents

( gives patient control, self determination, keeps good doctor patient relaionship)

• routine day to day care ( non objection = implied consent , but you need to tell them its implied)
  
  • implied consent given they probably know that the MDT works together. If not QO care and trt would be significatly comprimised.)
  • If they do not consent, inform them of the harms , but ultmatley they can say no)
• clincial audit
• Employers/insurers/ third party ( ex.benefits)
  
  • you need to consent - patient is sufficiently infomed, needs to be relevant to request, show patient copy before its sent, informed consent given.

2) Required by law

• notification of infectious diseases
• judge

3) Public interests

conf draws people to seek health.. overall good for society however if the conf info brings more harm to the public than keeping the trust that draws them to tell you in the first place, it must be broken ( cost benefit) .. however you must first try to gain consent from them first.

• if it benefits the public to know about thier condition
  
  • if someone who can’t drive drives* - people must inform DVLA - as a doctor you should remind them of this and persuade them to contact them, otherwise tell you would need to inform ( try everything before- last resort)
  • gunshot wound* - someone has a gun and is prepared to use it on others ( you dont have to give patients name but court might make you)
  • Serious communicable diseases - if patient consents, share / if they refuse to inform GP- they should be encouraged to do so - it should not be shared. ( GP not directly at risk of harm) // People who are at direct risk ( and its high enough) of harm should be informed if they are identifiable, you are permitted.

disclosing info should never be taken lightly

​you need to be able to justify ( look at GMC guidance shoulds and musts)

• Reasearch/Education

Question 6

Apply the ethical and legal framework regarding disclosure of patient information to your role as a medical student.

Answer 6

1. See trust policy - might vary
2. generally - Patients are owed a duty of confidence by health professionals and anyone with access to their personal and medical information
3. See Protecting Patient Sensitive Information: Community Learning Guidelines:

• Moodle page
• Community handbook page pg 55

Question 7

Summarise the confidentiality lecture

Answer 7

• Confidentiality is an important basis of the doctor-patient relationship;
• But the duty of confidentiality is not absolute;

–Some disclosures may be needed for routine care;

–Some disclosures may be required by law;

–Some disclosures may be justified in the public interest.