GP/ Patient confidentiality query.
Discussion
Has a General Practitioner a duty of total confidentiality to his patients or are some things OK to report?
I'd hazard a guess that murder confessions ( and similar ilk) would be OK, having a transmittable disease that the patient refused to have treated would also be OK.
Would pain killer/drug dependancy or alcohol abuse need to be reported?...and if so, to whom? Would it depend on what position the person had in society ie nurse, school teacher, publican etc?
I'd hazard a guess that murder confessions ( and similar ilk) would be OK, having a transmittable disease that the patient refused to have treated would also be OK.
Would pain killer/drug dependancy or alcohol abuse need to be reported?...and if so, to whom? Would it depend on what position the person had in society ie nurse, school teacher, publican etc?
Confidentiality may only be breached in rare circumstances.
Some are required by law, others when in the public interest or to protect the patient or others.
GMC guidance from http://www.gmc-uk.org/guidance/current/library/con... follows:
Disclosures in the public interest
22. Personal information may be disclosed in the public interest, without the patient’s consent, and in exceptional cases where patients have withheld consent, where the benefits to an individual or to society of the disclosure outweigh the public and the patient’s interest in keeping the information confidential. In all cases where you consider disclosing information without consent from the patient, you must weigh the possible harm (both to the patient, and the overall trust between doctors and patients) against the benefits which are likely to arise from the release of information.
23. Before considering whether a disclosure of personal information ‘in the public interest’ would be justified, you must be satisfied that identifiable data are necessary for the purpose, or that it is not practicable to anonymise the data. In such cases you should still try to seek patients’ consent, unless it is not practicable to do so, for example because:
the patients are not competent to give consent (see paragraphs 28 and 29); or
the records are of such age and/or number that reasonable efforts to trace patients are unlikely to be successful; or
the patient has been, or may be violent; or obtaining consent would undermine the purpose of the disclosure (eg disclosures in relation to crime); or
action must be taken quickly (for example in the detection or control of outbreaks of some communicable diseases) and there is insufficient time to contact patients.
24. In cases where there is a serious risk to the patient or others, disclosures may be justified even where patients have been asked to agree to a disclosure, but have withheld consent (for further advice see paragraph 27).
25. You should inform patients that a disclosure will be made, wherever it is practicable to do so. You must document in the patient’s record any steps you have taken to seek or obtain consent and your reasons for disclosing information without consent.
26. Ultimately, the ‘public interest’ can be determined only by the courts; but the GMC may also require you to justify your actions if a complaint is made about the disclosure of identifiable information without a patient’s consent. The potential benefits and harms of disclosures made without consent are also considered by the Patient Information Advisory Group in considering applications for Regulations under the Health and Social Care Act 2001. Disclosures of data covered by a Regulation4 are not in breach of the common law duty of confidentiality.
Disclosures to protect the patient or others
27. Disclosure of personal information without consent may be justified in the public interest where failure to do so may expose the patient or others to risk of death or serious harm. Where the patient or others are exposed to a risk so serious that it outweighs the patient’s privacy interest, you should seek consent to disclosure where practicable. If it is not practicable to seek consent, you should disclose information promptly to an appropriate person or authority. You should generally inform the patient before disclosing the information. If you seek consent and the patient withholds it you should consider the reasons for this, if any are provided by the patient. If you remain of the view that disclosure is necessary to protect a third party from death or serious harm, you should disclose information promptly to an appropriate person or authority. Such situations arise, for example, where a disclosure may assist in the prevention, detection or prosecution of a serious crime, especially crimes against the person, such as abuse of children.
Some are required by law, others when in the public interest or to protect the patient or others.
GMC guidance from http://www.gmc-uk.org/guidance/current/library/con... follows:
Disclosures in the public interest
22. Personal information may be disclosed in the public interest, without the patient’s consent, and in exceptional cases where patients have withheld consent, where the benefits to an individual or to society of the disclosure outweigh the public and the patient’s interest in keeping the information confidential. In all cases where you consider disclosing information without consent from the patient, you must weigh the possible harm (both to the patient, and the overall trust between doctors and patients) against the benefits which are likely to arise from the release of information.
23. Before considering whether a disclosure of personal information ‘in the public interest’ would be justified, you must be satisfied that identifiable data are necessary for the purpose, or that it is not practicable to anonymise the data. In such cases you should still try to seek patients’ consent, unless it is not practicable to do so, for example because:
the patients are not competent to give consent (see paragraphs 28 and 29); or
the records are of such age and/or number that reasonable efforts to trace patients are unlikely to be successful; or
the patient has been, or may be violent; or obtaining consent would undermine the purpose of the disclosure (eg disclosures in relation to crime); or
action must be taken quickly (for example in the detection or control of outbreaks of some communicable diseases) and there is insufficient time to contact patients.
24. In cases where there is a serious risk to the patient or others, disclosures may be justified even where patients have been asked to agree to a disclosure, but have withheld consent (for further advice see paragraph 27).
25. You should inform patients that a disclosure will be made, wherever it is practicable to do so. You must document in the patient’s record any steps you have taken to seek or obtain consent and your reasons for disclosing information without consent.
26. Ultimately, the ‘public interest’ can be determined only by the courts; but the GMC may also require you to justify your actions if a complaint is made about the disclosure of identifiable information without a patient’s consent. The potential benefits and harms of disclosures made without consent are also considered by the Patient Information Advisory Group in considering applications for Regulations under the Health and Social Care Act 2001. Disclosures of data covered by a Regulation4 are not in breach of the common law duty of confidentiality.
Disclosures to protect the patient or others
27. Disclosure of personal information without consent may be justified in the public interest where failure to do so may expose the patient or others to risk of death or serious harm. Where the patient or others are exposed to a risk so serious that it outweighs the patient’s privacy interest, you should seek consent to disclosure where practicable. If it is not practicable to seek consent, you should disclose information promptly to an appropriate person or authority. You should generally inform the patient before disclosing the information. If you seek consent and the patient withholds it you should consider the reasons for this, if any are provided by the patient. If you remain of the view that disclosure is necessary to protect a third party from death or serious harm, you should disclose information promptly to an appropriate person or authority. Such situations arise, for example, where a disclosure may assist in the prevention, detection or prosecution of a serious crime, especially crimes against the person, such as abuse of children.
I don't think they are required to report any kinds of dependancies on drugs or alchohol as patient confidentiality is held in pretty high esteem. If they were psycho and threatening to kill someone, then I think they have a duty to notify the police etc.. but if they have AIDS etc. then no, I don't believe there is any duty to notify any authority.
I could be wrong. I can also check with a friend who is a GP if you wish, but I think if you look at the GMC website they have details of what sort of things a GP can and can't do in respect of patient confidentiality.
ETA, I guess I was typing when a slightly better answer !
I could be wrong. I can also check with a friend who is a GP if you wish, but I think if you look at the GMC website they have details of what sort of things a GP can and can't do in respect of patient confidentiality.
ETA, I guess I was typing when a slightly better answer !
Edited by Jasandjules on Wednesday 4th March 21:37
condor said:
a transmittable disease that the patient refused to have treated would also be OK.
Disclosing that sort of information would get you struck offcondor said:
Would pain killer/drug dependancy or alcohol abuse need to be reported?...and if so, to whom? Would it depend on what position the person had in society ie nurse, school teacher, publican etc?
Most likely circumstances this would be disclosed would be in an employment or insurance medical where the patient has signed to agree disclosure.Again outside of GMC guidance disclosing this would be viewed very seriously
condor said:
Thanks 
Although trying to be general about it, I was thinking more along the lines of if a publican had delirium tremens would his doctor feel obliged to report it as he 'worked' with alcohol ?
No I don't think that would be the case at all. The question is not whether the Doctor feels obliged to report it, but as I understand it, a doctor must basically keep everything exceedingly confidential unless obliged by Law to disclose. Although trying to be general about it, I was thinking more along the lines of if a publican had delirium tremens would his doctor feel obliged to report it as he 'worked' with alcohol ?condor said:
It could then be argued that as a licencee and responsible for serving alcohol to others, if he wasn't a fit person to be in charge of supplying alcohol, then he should have his suitability to hold a liquor licence questioned.
If you have a driving license but suffer from DTs, then you run the risk of being drunk in charge of a motor vehicle and killing someone. Same goes for an alcholic who operates a crane, or is a Doctor................They may kill someone in such a state. But then, the same is true for druggies. Yet none of these details are disclosed to employers or indeed anyone else because the Duty of a Doctor is to treat the patient, not everyone else in the world who may be affected. Does a Doctor refuse to treat the man who has hurt his hand whilst beating his wife up? Because he can do it again once his hand is better. No. Does he report the man to his employer in case he beats up another employee? No.A GP could not defend breaking confidentiality in the circumstances you describe. An Occupational Physician may disclose a limited amount of information if employed to do so with regard to the publican's fitness to work, but would first seek consent.
AS for the communicable diseases mentioned above some are specifically legislated for, "Notifiable Diseases".
AS for the communicable diseases mentioned above some are specifically legislated for, "Notifiable Diseases".
condor said:
publican had delirium tremens would his doctor feel obliged to report it as he 'worked' with alcohol ?
No the doctor would regard working with alcohol as a risk factor for alcoholism. Chefs, hotel workers and landlords along with doctors of course are all at excess risk. If we couldn't get a drink from alcoholic pub landlords a lot of us would be going thirsty.PSV driver with DTs on the other hand - tricky.
condor said:
So then his GP was making an idle threat that he needed to report it, presumably to check his reaction to the threat or to scare him out of his drinking?
Boozers tend to be very twitchy and thin skinned with the medical profession so he may have got the wrong end of the stick. For the hardcore (and to get DTs you have to be hardcore) an encounter with the medical profession is one of the few things that gives them a reality check.I'd be surprised if the GP was making idle threats, he/she might have been suggesting 'refer' (for help) or commenting on the impact the boozing may have on his business.
If the guy's got DTs he's hardly likely to recall the consultation 100% accurately
condor said:
He didn't realise that he'd experienced DTs until his GP diagnosed it - and thought he'd just had a weird experience ( hallucination and delusion symptoms). Was just he was concerned as his GP said he'd have to report it, and he doesn't want to lose his job.
The only time the GP "could" disclose information about your friend would be if something happened, criminally with the business and your friend was in the frame. Technically, if something happened to your friend's business from a criminal angle, police could request, if they got wind that your friend had a drink problem and it had a bearing on the case, for his GP to disclose relevant medical information. However, AFAIK, your friend's permission to disclose this information would be sought first and nothing, given the above scenario, could be passed over without his permission.
Gassing Station | Health Matters | Top of Page | What's New | My Stuff