The principles

The GMC’s Good Medical Practice (2006) makes it clear that “patients have a right to expect that information about them will be held in confidence by their doctors”. Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to give doctors the information they need in order to provide good care.

The GMC’s Confidentiality (2009) states that when disclosing information about a patient, you must:

• “Use anonymised or coded information if practicable and if it will serve the purpose
• Be satisfied that the patient:
  • has ready access to information that explains that their personal information might be disclosed for the sake of their own care, or for local clinical audit, and that they can object, and
  • has not objected
• Get the patient’s express consent if identifiable information is to be disclosed for the purposes other than their care or local clinical audit, unless the disclosure is required by law or can be justified in the public interest 
• Keep disclosures to the minimum necessary, and 
• Keep up to date with, and observe, all relevant legal requirements, including the common law and data protection legislation.”

Problems with confidentiality do not normally result in negligence claims, but they can lead to complaints and/or a referral to the GMC. 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 2009, 100% had risks associated with confidentiality, including:

• Patients able to overhear conversations at the reception desk.
• Patients waiting at the reception desk seeing the computer screen.
• Patient-identifiable information left lying around on desks in the office and consulting rooms.
• Staff contracts including a clause relating to confidentiality that does not extend to staff post-employment. 
• Staff as patients - concerns about maintaining confidentiality.
• Leaving messages for patients on answering machines.
• Set fax numbers not used when sending patient-identifiable information.

Good Medical Practices (GMP) in action

The GMC has added new interactive medical and ethical dilemmas to explain how doctors should tackle real-life issues using updated GMC guidance on confidentiality and supplementary guidance. New scenarios include dealing with and reporting knife wounds and contacting the DVLA with concerns about a patient’s safety as a driver (click here for more information).