Breeching Confidentiality
Definitions
Confidentiality: Keeping a patient’s health information private from others unless the patient enables the release of this information or there is a clinical need to discuss with colleagues.
British Medical Council - Medical Ethics Report
This was an investigation conducted by medical students on hospital placements to see how common breeches of confidentiality (wrongly) occurred. The main findings of the study found:
On average there is a breech of confidentiality once every 62.5 hours in a hospital.
The most common confidentiality breech was with another doctor not involved in the patient’s care which included personal/patient identifiable information (55%).
The second most common breech was infrastructure breeches which involved informing patients in public areas or conducting examinations in rooms where other patients were present. This type of breech is due to a shortage of space or equipment.
40% of breeches were in public areas including corridors, canteens, stairs etc.
Breeching Confidentiality
When breeching confidentiality, the doctor must weight up:
The harm caused to the patient and society by disclosing the information:
Patient notes include subjective impressions on the patient’s lifestyle and habits. Improper handling of these could cause humiliation and distress to the patient.
Loss of trust in the NHS from the patient and members of the public.
Breakdown of the doctor-patient relationship - less likely to attend appointments or disclose personal information which may be critical in finding future diagnoses.
Abandonment of core NHS values e.g “dignity and respect” and “compassion”.
Doesn't respect Autonomy, Beneficence or Non-Maleficence, three of the pillars of medical ethics.
The benefits to society by disclosing the information:
The potential harm to society that can be prevented.
When Confidentiality Can Be Broken
Confidentiality can be broken if the patient has the capacity to consent and allows the release of the information. Alternatively, it can also be broken if the information is:
Required by Law (e.g the department of health for Covid cases).
Required by Court Order (in a specific trial for a patient).
Required for public Interest including:
Gunshot wounds and stabbings.
Terrorist activity.
Research. For example taking PrEP (a drug taken to reduce the viral count in patients with HIV) in Wales automatically includes you in a study.
HIV - if the patient won’t, the doctor has the duty to inform the patient's partner.
Unfit to drive (seizures, dementia etc.) - if the patient won’t, the doctor must inform the DVLA.
However, if breeching confidentiality, regardless of age, the doctor must:
Initially try and encourage the patient to do it themselves.
Inform the patient that they will have to breech confidentiality.
Use the minimal amount of patient identifiable information possible (e.g in studies, gunshot wounds).