CONFIDENTIALITY


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


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appropriate for the Gardaí. If in doubt, contact MPS for advice.


Confidentiality after death Your duty of confidentiality extends beyond the patient’s death. It is advisable to get the consent of the next of kin or executor of the estate before releasing any information. Any approach for access should be considered in the light of the patient’s best interests. If you are unsure whether the patient consented to disclosure after their death, the Medical Council advises that you “should consider how disclosure of the information might benefit or cause distress to the deceased’s family or carers”. There may be


circumstances where limited disclosures may be justified. For example, you have a professional duty to respond to complaints, and this includes complaints made by bereaved relatives. Any disclosure must be justifiable and the reasons for doing so must be fully documented. Always consider matters that the deceased would have wished kept private and do not breach the confidentiality of third parties.


Media There may be occasions where the media ask for information about individual


patients. For example: ■■ Updates on the condition of particular patients, eg, celebrities.


■■ After newsworthy incidents, eg, violent crimes or road traffic accidents.


■■ When someone is complaining publicly about their treatment.


Where practicable, the explicit consent of the patients concerned should be obtained. Where consent cannot


be obtained or is withheld, disclosure may still be justified in the “exceptional” public interest. A patient complaining about treatment would normally not be considered an exceptional circumstance. A dignified silence is often the best approach to take, but do not hesitate to contact MPS for advice on dealing with the media. See the MPS Media Handling Guide for more information. www.medicalprotection. org/ireland/booklets


Insurance companies Reports for insurance companies should be completed fully, with the consent of the patient. The onus is on the doctor to ensure that they have adequate informed consent for the release of medical information. This is particularly important with disclosures that have far-reaching personal, professional or financial consequences, eg, disclosures to insurers and employers. It is crucial to check with patients the scope of the consent that they have agreed and consider the relevance of disclosures. Patients may not appreciate that they have agreed to full disclosure when signing a generic consent form. Patients should be told that the reports may be read by non-medical personnel. The


report should be sent to the medical officer acting on behalf of the company.


Access to records More details on providing access to medical records can be found in the previous issue of GP Trainee on medical records: www.medicalprotection. org/gptrainee Care should be taken


when forwarding records following a request. They should be sent by recorded delivery or by registered post to ensure they are received by the intended recipient.


Unintentional breaches to relatives You should be careful not to breach a patient’s confidentiality to their


Case scenario 1


Jane, 26, accompanied by her mother, attends an appointment with Dr Burns. Jane has an ongoing depressive illness where she has required regular family support, which was why Jane’s mother accompanied her to the surgery. During the consultation, Dr Burns proceeds to talk about relevant personal matters in front of Jane’s mother, without Jane’s explicit consent. Subsequently, Jane falls out with her mother and


makes a complaint to the Medical Council, and although it doesn’t make it to a hearing, MPS had to arrange representation for the GP.


Learning points: The implied consent upon which our member relied in this consultation should not necessarily be taken for granted. Always double-check with the patient.


Case scenario 2


Sixteen-year-old Amy, accompanied by her mother, attends an appointment with Dr O’Sullivan, in order to discuss the management of her hayfever. Unbeknown to Dr O’Sullivan, her computer screen is turned at such an angle that Amy’s mother can read Amy’s medical history. Dr O’Sullivan recently put Amy on the contraceptive pill and she expressly indicated that she did not wish her mother to know. Unfortunately it is now too late. Amy’s mother is shocked


and angry in relation to what she has read and Amy is not only embarrassed, but furious that her confidentiality has been breached in this way. Dr O’Sullivan has some explaining to do and it will be difficult for her to rebuild the doctor–patient relationship with either Amy or her mother.


Learning points: Be aware that if a patient is accompanied, they may not want their companion to know all their details, ie, the patient hasn’t given consent for the relative/friend to see all their personal information.


relatives, even where they have attended the consultation. Even if you have had consent from a patient, it is worth double-checking by asking the patient in front of the relative. This applies to both adults and children.


Clinical audit The Medical Council in its Guide to Professional Conduct and Ethics advises: “When patient information is to be used as part of clinical audit and quality assurance systems, you should anonymise the information as far as possible.” If you are acting as an investigator in a clinical research trial or any form of medical research, you must submit and receive approval from the relevant research ethics committee before research begins.


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