What do you need consent for?

Consent extends to all aspects of the doctor–patient relationship.

Confidentiality and disclosure

You need a patient’s consent to disclose information about them. Patients understand that in order to provide appropriate care, you will have to share information with other healthcare professionals. You should ensure that patients are aware their information will be shared, unless they specifically object (see also “Referrals” on page 7). You may be asked to disclose information about patients that will have no effect on them personally, for example for the purposes of:

• Education and research
• Clinical audit
• Health service administration
• Public health safety.

Express consent is only needed if the information identifies the patient – otherwise anonymising the data will suffice. All such disclosures should be kept to a minimum. If the patient will be personally affected by the disclosure, eg, if you are giving personal information to their employer or an insurance company, you must have their express consent. A common example in general practice is an approach from an insurance company wanting a report on a patient who is making a claim. You must ensure that consent has been obtained and that the patient is well-informed in order for consent to be valid. You may wish to invite the patient in to discuss the disclosure.

Public interest

You can disclose information without consent if it is in the public interest. The GMC advises that you should 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 or manslaughter.

Some communicable diseases are notifiable by statute, and notification should preferably be made with the knowledge of the patient. Disclosure of medical records is covered in more detail in the editions of GP Registrar on medical records and confidentiality.

Screening

Screening can be important in providing effective care, but, as the results may have serious implications, consent should be taken carefully. In particular: 

• There may be uncertainties with the test, such as false-positive or false-negative results.
• Some tests could have serious consequences for patients and relatives – affecting their health, social circumstances and finances.

So when taking consent for screening, pay particular attention to these issues, and remember to look at how the testing will be followed up, for example with counselling or other support.

Patients who do not want to know

Some patients may not want to know all the details about treatments and their attendant risks and benefits, making it difficult to secure their valid consent. If a patient does not want to know in detail about their condition or the treatment, you should respect their wishes, as far as possible, but the GMC stresses you “must still give them the information they need in order to give their consent”.

You must record the fact that the patient has declined information.

Research

Research is an important way of improving the treatment of patients, but the benefits to the individual patients involved may not always be clear. Consent for any research project should be taken particularly carefully, and refusal to participate must not influence the ongoing care of the patient in any way.

Teaching

Patients need to consent to their involvement in any part of the teaching process. The practice should make it clear that they are a training practice. You should be honest with patients that you are a trainee GP. It is unlikely that any patient will object to you treating them. If they do, you may wish to reassure them about your qualifications and experience, but if they still refuse their consent you should respect their wishes. Similarly, if you are using information about patients for training purposes, you will need their consent.