12


It is not the medical profession’s responsibility to maintain law and order – its duty is to provide care to those who need it, non-judgmentally, without fear or favour. If doctors lose sight of that, we are doomed


“Recently, a patient told one of my juniors that they had a shotgun at home. The patient had attended with depression and had expressed suicidal intent,” says Dr Jonathan Jones, Emergency Medicine Consultant at Leeds General Infirmary. “I actually discussed the situation with a mediocolegal adviser at MPS. Following that discussion, I spoke to the patient and clarified the story – they sometimes borrowed a shotgun their uncle kept in a locked gun cupboard and they had some shotgun cartridges at home. I felt that the situation was low risk and we did not inform the police.”


Making moral judgments Dr Jonathan Jones adds: “As EM consultants we are expected to make moral judgments on the severity of a crime and when to disclose – and this is tricky. Not so long ago, a nurse found that a patient had a carrier bag full of marijuana plants. The patient had attended with mental health problems and claimed they had found it in a bus stop. The nurse contacted our pharmacist, as is policy when it comes to disposing of illicit substances. Because of the volume of material, she could not use the normal processes for disposing of the material and so the police were called. The police were keen to have the patient’s details. I felt that this did not constitute a serious arrestable offence – they disagreed, arguing that clearly the patient had access to marijuana being grown, which


REFERENCES


1. GMC, Confidentiality p16, 2009 www.gmc-uk.org 2. NHS, Confidentiality Code of Practice, p35, 2003 3. NHS, Confidentiality Code of Practice Supplementary Guidance: Public Interest Disclosures, p9, 2010 4. Ibid p6 5. MPS factsheet, Confidentiality: Disclosures Without Consent www.mps.org.uk 6. HM Government, Prevent strategy p83, 2011 www.homeoffice.gov.uk/publications 7.


ibid


8. Laurance J, Medical life: Patients’ trust must not be betrayed in the wake of the riots, The Independent, 23 August 2011


9. GMC, Supplementary Guidance Confidentiality: Reporting Gunshot and Knife Wounds, 2009 www.gmc-uk.org


could be classed as intent to supply, meaning it was a more serious offence. I asked them to get written authority and a request for disclosure of personal data from an inspector or above, before I would then consider their request further.”


Professional and personal response There is, perhaps, a difference between a citizen’s duty and the duty of a medical professional. Dr Su Jones says: “Always ensure that you can justify your decision to break patient confidentiality. Don’t get caught up in any public frenzy; have a measured, professional response in situations such as large-scale public disorder and rioting. Reflect on whether the disclosure is really in the public interest to avoid a knee-jerk reaction.” Whilst doctors should not turn a blind eye to petty crime, it is their professional responsibility to disclose confidential patient information only when there is a serious threat to public safety. Doctors are highly-regarded as upstanding members of society, but ultimately their professional duty has to lie with the individual patient. The Independent’s Health


Editor Jeremy Laurance sums up the debate eloquently: “It is not the medical profession’s responsibility to maintain law and order – its duty is to provide care to those who need it, non-judgmentally, without fear or favour. If doctors lose sight of that, we are doomed.”8


CASE STUDY


A 23-year-old male, Mr N, is brought in to the hospital by paramedics with a gunshot wound to his left leg. He becomes extremely distressed when Dr S begins to take a detailed history. When Dr S suggests reporting the crime, Mr N becomes very aggressive and starts to threaten Dr S, warning him not to call the police. What should Dr S do?


D


Advice The GMC states that doctors should inform the police quickly whenever a person arrives with a gunshot wound or knife injury, in order to allow police to make an assessment of the risk to the patient and others and to record the crime for statistical purposes. However, Dr S should make a professional


judgment about whether to disclose Mr N’s name and other personal information. If it is probable that a crime has been committed, and Mr N is unwilling to disclose information or allow doctors to do so, Dr S can speak to the police if the information is required by law, or is in the public interest. If you decide not to tell the patient about the disclosure as it may put you or others at risk of serious harm, or prejudice the prevention, detection or prosecution of a crime, you must document this decision and be prepared to justify it.


r S is an Emergency Medicine consultant working the night shift in a busy city centre teaching hospital.


SPECIAL FEATURE


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


DU CANE MEDICAL IMAGING LTD/SCIENCE PHOTO


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