Confidentiality

Question 1

When can confidentiality be broken?

Answer 1

Express consent is given by the patient – how much, to whom?

It is required by the law

In the wider public interest – tell police if pt will commit serious violent offence (gun/knife), DVLA (prevent harm to others)

Implied consent – MDT to discuss plan – med students not part of team

Question 2

What should you do if you have broken confidentiality?

Answer 2

When required to breach confidentiality, give the minimum amount of information necessary

It is generally good to inform the patient when you have to breach confidentiality (unless it defies the objective of breaching confidentiality)

Question 3

What are the rights of relatives?

Answer 3

Relatives DO NOT have a right to know about the patient unless they are the parent of a child who is not Gillick competent (confidentiality continues after death)

If a patient lacks competence, next of kin have a right to be consulted where practical to do so

Express consent is required if there is doubt about the sensitivity of the information (e.g. GUM appt/GP letter)

Question 4

What are the disclosures required by statute that do not require consent?

Answer 4

Notification of death – ask coroner what to put on death certificate if there are any queries

Notification of termination (to Chief Medical Officer of all abortions)

Treatment of drug addicts with specific drugs

Notable infectious diseases (measles, acute meningitis, food poisoning, malaria, MMR, TB)

Question 5

What are conditions which require disclosure to the police?

Answer 5

Under a warrant from a circuit judge

To aid a police request to identify drivers suspected of road traffic offences (can give identity and address, don’t have to give info to secure conviction)

To aid police in all matters regarding terrorism

No legal duty to inform DVLA but professional responsibility to inform DVLA – tell pt before

Question 6

What are the rules for confidentiality in children?

Answer 6

Confidentiality can be breached with parental consent/if in the best interests of the child (abuse)

Competence is assumed at 16, but confidentiality can be breached between 16-18 if it is in the best interest of the child (generally not in BI to breach if 16+/Gillick competent – discuss with senior)

In adults lacking mental capacity and in children, confidentiality can be breached if in their best interests

Question 7

What are situations in which drs would not be justified in breaking confidentiality to the police?

Answer 7

Theft

Fraud

Damage to property