CONFIDENTIALITY


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


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Communication with others A


s well as those occasions where disclosure is


prescribed, there are other occasions where a breach of confidentiality may be justified. The Medical Council advises that this may happen when necessary to protect the interests of the patient, the welfare of society or to safeguard the welfare of another individual or patient.


Public interest disclosures Disclosure of patient information without consent may be justifiable in exceptional circumstances where it is necessary in the public interest. If health protection staff request it, you may share relevant patient information where it is necessary to protect the public. Before making such disclosures you should consider the possible harm that may result to the patient, as well as the benefits that are likely to arise.


Children Confidentiality within family situations can be difficult. In general, the Freedom of Information Act allows access by parents or guardians to the medical records of children. When relationships break


down, disputes involving the children can spill over into their healthcare, with one parent asking for information on a child’s health or to see medical records.


In these cases, you need


to be clear about whether those applying for information are parents or guardians. If in doubt, ask for clarification. You may also need to consider the wishes of those minors under 16 years old. The interests of the child are paramount. This is a contentious area which may benefit from medicolegal discussion – if in doubt contact MPS for advice.


Older children Remember that adolescents are entitled to confidentiality. From age 16 a young person can visit the doctor without the knowledge of a parent. Just confirming the young person has attended may breach confidentiality, and doctors need to be cautious about such enquiries regardless of age. Children over 16 years


can also consent to medical and surgical treatment (Non-Fatal Offences against the Person Act 1997) and from this age there is a clear expectation of confidentiality in medical matters. The Law Reform Commission is currently undertaking a review of the law regarding consent to treatment by mature minors. Any changes are likely to impact on the issue of confidentiality of the medical records of such minors.


Child abuse You should be aware of national guidelines for the


protection of children: ■■ Children First – National Guidelines for the Protection and Welfare of Children provides guidance on sharing information for the purposes of child protection.


■■ The Protection for Persons Reporting Child Abuse Act (1998) provides immunity from civil liability to those who report child abuse “reasonably and in good faith” to a designated officer of a health board or the Gardaí. The guidance also advises that “giving information to others for the protection of a child does not constitute a breach of confidentiality”.


If you have any concerns regarding alleged or suspected sexual, physical or emotional abuse or neglect of children, you must report this promptly to an appropriate agency. The Medical Council’s


Guide to Professional Conduct and Ethics states: “You should inform the child’s parents or guardian of your intention to report your concerns unless informing the parents or guardians might endanger the child.” This is considered a particularly important issue by child welfare advocates, as children may be placed at immediate risk following


disclosure and reporting. It is important to be aware of this complex and difficult issue – you may benefit from discussion with a senior colleague.


Gardaí There can be a conflict between the need to maintain the confidentiality of patients and the need to be a good citizen and help the Gardaí with their duties. It would be sensible to consider disclosing information without the consent of a patient where this will assist in the prevention, detection or prosecution of a serious crime.


Serious crimes, in this context, will put someone at risk of death or serious harm, and will usually be crimes against the person, such as abuse of children. Great care is needed in these circumstances in considering whether a limited disclosure is justifiable or relevant. In most circumstances you should ask that the patient’s consent be provided. Gardaí often ask for information that is not directly pertinent to a death or alleged crime, and GPs need to be careful about information they give and how this might be interpreted. GPs need to be cautious that they only answer direct relevant questions. Information that is appropriate for the coroner may not necessarily be


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