Section 2Confidentiality conundrums
HIV disclosure MDU advice
An MDU member, a senior trainee in obstetrics, The MDU adviser referred the member to the GMC’s
had been standing in for the consultant, who was guidance in their publication Confidentiality: protecting
away. A 38-year-old solicitor had attended the and providing information(2004). Confidentiality is a
clinic at 22 weeks in her first pregnancy. The cornerstone of medical care, but doctors also have a
patient had come to the consultation alone and responsibility to act in the public interest (paragraphs
was clearly distressed. 22-27) and, in a situation where the doctor believes that
The patient admitted that, although she had not
a disclosure of information without consent may be
disclosed the information to anyone else during the
necessary to protect a third party, the possible harm to
pregnancy, she had had a positive test for HIV a few
the patient and to the overall trust between doctors and
weeks before discovering that she was pregnant and had
patients must be weighed against the benefits which are
not yet started any treatment because, as she explained,
likely to arise from the release of information. The GMC
she had been ‘in denial’. She said that this had followed
expects that, in such cases, consent should be sought
a brief affair, and that she could not tell her husband,
from the patient and that, if consent is withheld and the
who she believed to be the father of her baby. She asked
doctor still believes disclosure to be necessary to ‘protect
the member to help her get treatment for the HIV to
a third party from death or serious harm’, then the
protect the baby, but not to tell the husband.
doctor should disclose promptly to an appropriate person
or authority.
While the member was still in clinic she called the MDU
advice line, having asked the patient to wait outside.
The member was advised to discuss this case with
She was not sure how to proceed, and was concerned
whichever consultant colleague was standing in for the
that the husband would be at risk if not informed.
usual supervising consultant, and also with the Trust’s
Caldicott guardian, and to keep a clear record of the
discussions and of the reasons for either disclosing or,
indeed, for a decision not to disclose.
The member called again a few days later. She had
decided after discussion with the supervising consultant
and Caldicott guardian that it would be appropriate to
disclose the minimum necessary information to the
patient’s husband on the basis that a failure to do so
would be potentially harmful to him. The member and
supervising consultant had seen the patient again,
together, and had explained this to her. The patient said
that she had considered the situation further and
appreciated that her husband had to be told. She said
that, after some agonising, she had decided to do this
herself.
The doctors were delighted to hear this, but didn’t
entirely believe that she would go through with her
promise, so they asked her to bring her husband to the
next consultation in a few days’ time. When the husband
attended the next consultation, with the patient, it was
clear that he was aware of the situation.
“...still in clinic she called the MDU advice line...”
22
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74