Section 2Confidentiality conundrums
A phantom pilot MDU advice
An A&E consultant had recently assessed a patient The member was advised that information of a private or
who had suffered a deep vein thrombosis in her sensitive nature, obtained during a consultation, must
calf a few weeks earlier. The patient did not attend not usually be disclosed to others unless the patient has
for follow-up appointments and it seemed likely consented, or disclosure is required by law or a
she was not fully compliant with her anti-coagulant court/tribunal order. However, there may be rare
treatment. The consultant was concerned about occasions when disclosure of information in the public
this. But what really concerned him was that the interest may be justified in the absence of patient
patient had stated she was working as a commercial consent, or when patient consent is withheld.
airline pilot.
The GMC provides guidance in its publication
The consultant wondered whether this was in fact true – Confidentiality: Protecting and Providing Information
there was something unconvincing about the patient’s (2004). It states that disclosure may be justified in the
manner. Nonetheless he had stressed to the patient the public interest where failure to do so may expose the
risks to her health of flying, particularly if she was patient or others to a risk of death or serious harm.
inadequately anti-coagulated. He had also stressed the The GMC advise that when deciding whether to disclose
risk to passengers. He strongly advised the patient to information in the public interest, doctors should try to
inform the Civil Aviation Authority (CAA) of the situation. obtain consent from the patient for disclosure of
After much thought, and doubtful that the patient
information. If seeking consent is not practicable, poses
would contact the CAA, the consultant wondered
a risk to the safety of the patient, doctor, or other
whether he should disclose the information in his
person, or might defeat the object of the disclosure, a
possession. He contacted the MDU advice line to discuss
disclosure should be made promptly to an appropriate
the case.
person or authority.
Generally the patient should be informed before
information is disclosed without their consent, and
doctors should consider any reasons the patient gives
objecting to a disclosure. However, if the doctor remains
of the view that there is a risk of serious harm or death
to the patient or to a third party, then information
should be disclosed promptly to an appropriate person or
authority.
Doctors may be required to justify any disclosure of
confidential personal information in the absence of
patient consent to the GMC, so it is important to keep
good records of the decision making process.
After discussing the case with the MDU, the member
contacted the patient’s registered GP initially to try and
establish a clearer picture of the clinical situation. The
patient had only recently registered with the GP, but had
received prescriptions for warfarin.
The member then contacted the patient and sought
further information. The patient was quite relaxed about
this enquiry and said she was not intending to fly again
for twenty-eight days as she was “off-duty”. At this
point the member advised the patient that he had an
overriding ethical duty to inform the CAA as he had
serious concerns about her continuing to work as pilot.
The patient seemed unconcerned.
The consultant then contacted the CAA and was
informed that there are very stringent policies in place
for managing aircrew with a history of a thromboembolic
disorder. Any flying would be subject to total restriction
“Doctors may be required to justify
for a period of time, followed by extensive health
assessments.
any disclosure of confidential personal
In light of this information, the consultant disclosed the
information in the absence of patient
patient’s details, but no trace of this person could be
found on the CAA register of pilots in the UK. The member
consent to the GMC…” left any further investigation in the hands of the CAA.
20
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