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The Apprentice -
Can you keep a secret?

By Dr Laura Davison who is a GP in Milton Keynes

Following a number of practice meetings I had some real corkers to tell from the “field” about dilemmas in discretion and confidentiality. I re-read the GMC guidelines on confidentiality to enable me to accurately pass on key points that came of the controversial stories but actually came to the conclusion that...I can’t actually tell you anything. Nothing. Zip. Unless you don’t mind reading a story about Mr X who came to see Dr Y about his disturbing A and Dr Y didn’t know who to ask for help about A just in case B happened and confidentiality had to be broken. Or the other particularly tricky tale about Dr Z constantly complaining about Mr T to Dr M. Dr M knows all about Mr T and wants to help but can’t because it breaches confidentiality of two parties; so instead is putting Mr T and Dr Z through the anxiety-inducing arduousness of P. You see the problem?!

Providing the care of your patient is paramount but then you have the responsibility to protect the public too

Disclosing information, even for educational purposes, requires patient consent. You may anonymise cases for reports and no consent would be necessary, but seeing as you know my name, location, occupation and even what I look like, you could probably work out the cases’ identities just through a quick Google if I included too many facts. And what if X, Y and Z read this article too?! Calamity.

The crux of my cases was really a predicament around patients that might be a risk to themselves or others. We discussed a particularly tricky case in one practice meeting. The debate raged on and on until the coffee and sandwiches ran dry. What counts as a “need to know” basis these days? And how do you control the disclosure once it’s ‘out there’ with another party? The old “tap nose, wink wink” approach is no longer effective in secret keeping. There is a huge element of trust versus risk.

Disclosing information, even for educational purposes, requires patient consent

The GMC guidance has common themes on information keeping. It’s patient interest versus public interest. Confidentiality is a legal requirement, but for both patient AND public. So which do you pick? Whose side are you on? Providing the care of your patient is paramount but then you have the responsibility to protect the public too. It’s surely a Catch-22. One will not thank you for your decision whichever way you go. It’s eternally debatable. In the end, our practice has chosen to keep our patients’ trust for now. We felt as long as you can justify (and document!) your decision, you should survive these dilemmas with only emotional bruises rather than legal ones.

Is it just me that feels so encumbered by these confidential revelations that patients entrust to me? Can I tell a secret? Should I?

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