2 Confidentiality


A problem with confidentiality is a common reason for a call to MPS. Doctors at any stage of their career can find themselves faced with a complex situation where confidentiality issues are raised and expert advice is helpful.


In Ireland it is a particularly important issue. With a small population, and many people sharing the same name, accidental breaches of confidentiality can easily catch out the unwary.


This issue of GP Trainee takes you through the basic principles, and highlights some areas to be cautious of as you begin working in general practice. We also look at those occasions when, by law, you should breach confidentiality, and offer some guidance on the more difficult situations you may face.


Keeping confidences is vital in establishing the trust of patients. Patients have an expectation of privacy when they consult their doctor. As a GP, with an ongoing relationship with patients, managing trust is vital.


Charlotte Hudson Editor


EDITORIAL TEAM


Dr Mary Favier Dr George Fernie


COVER: © RICK WALKER 2009


sets out the standards it expects:


The principles I


n A Guide to Professional Conduct and Ethics (2009), the Medical Council


“Confidentiality is a fundamental principle of medical ethics and is central to trust between doctors and patients. Patient information remains confidential even after death.” Without assurances about confidentiality, patients may be reluctant to give doctors the information they need in order to provide good care. In certain circumstances, disclosure of information may


be required by law, which is not limited to but may


include: ■■ When ordered by a judge in a court of law, or by a tribunal


■■ To protect the interests of the patient


■■ To protect the welfare of society


■■ To safeguard the welfare of another individual or patient.


In these instances, you should inform patients of the disclosure and the reasons for it. It is useful to discuss such


a case with a trainer or senior colleague before


making a decision re disclosure. Problems with confidentiality do not normally result in negligence claims, but they can lead to complaints and/or a referral to the Medical Council. Whatever decision you


take you must be prepared to justify it. As this may well be a considerable time after the event, it is a good idea to make a comprehensive note of your reasoning in the patient’s records at the time.


Clinical Risk Self Assessments (CRSAs)


MPS Educational Services undertake Clinical Risk Self Assessments (CRSAs) in general practices to help identify risks of harm to patients and staff. Of practices visited during 2011, 100% had risks associated with confidentiality, including:


■■ Patients able to overhear conversations at the reception desk. ■■ Information available to third party (relatives/friends). ■■ Patients waiting at the reception desk seeing the computer screen. ■■ Patient-identifiable information left lying around on desks in the office and consulting rooms.


■■ Set fax numbers not used when sending patient-identifiable information. ■■ Staff contracts including a clause relating to confidentiality that does not extend to staff post-employment.


■■ Staff and their families as patients – concerns about maintaining confidentiality. ■■ Leaving messages for patients on answering machines.


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CONFIDENTIALITY


GP TRAINEE | VOLUME 5 | ISSUE 2 | 2012 | IRELAND www.medicalprotection.org


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