10


A duty to treat …and to tell?


Confidentiality is the foundation stone of the doctor– patient relationship. However, it is not absolute; disclosures are allowed without consent in instances where it is in the public interest to do so, and such disclosures are sometimes even required by law. Sarah Whitehouse looks at a doctor’s responsibility to their patients and to society


and society to the fore. The GMC states that disclosure of a patient’s personal information may be in the public interest, if it is likely to protect individuals or society from risks of death or serious harm, such as serious communicable diseases or serious crime, or as a result of gunshot or knife wounds.1 Similarly, the NHS


R


Confidentiality Code of Practice states that “serious harm to the security of the state or to public order and crimes that involve substantial financial gain or loss” will general fall into the category of serious crime.2


ioting in England in August 2011 brought this dual responsibility to patients


be classed as serious. The wider context is important, as sometimes crimes may be considered as serious where there is a prolonged period of incidents, even though they might not be serious on their own.3


For example, a patient


presents at the emergency department (ED) with


Does this cover


passing on information about a patient’s involvement in public disorder? It does if it threatens the public interest, but the ethical shades of grey become even more blurred in instances where the crime cannot immediately


unexplained cuts to their hands and wrists. It later emerges that these injuries were sustained whilst looting a sports shop for a pair of trainers. This is, of course, a crime, but is it in the public interest to disclose this confidential patient information? How far should doctors make morally charged decisions about how serious a crime has to be before it is reported?


Primary duty is to your patients MPS Senior Medicolegal Adviser Dr Su Jones says: “It is important to remember that


a doctor’s primary duty is to their patient. It is helpful to document any decisions and discussions that have taken place. You should document your disclosure.” She adds: “If you are unsure whether or not to share information, seek advice from an experienced colleague, or call MPS for advice.” Breaking confidentiality in instances where there is not a clear and justified public interest can erode the confidential nature of the doctor–patient relationship. Without confidentiality, patients may be reluctant to seek treatment or disclose their full history or nature of their injuries, which may compromise their health and erode patients’ confidence in the profession. In addition, it is important to consider the extent of information which is to be disclosed – disclosing demographic data or the fact that someone attended a clinic


SPECIAL FEATURE


UNITED KINGDOM CASEBOOK | VOLUME 20 | ISSUE 1 | JANUARY 2012 www.mps.org.uk


1000 WORDS / SHUTTERSTOCK.COM


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