Confidentiality is one of the oldest precepts of medical ethics and is mentioned in the famous Hippocratic Oath (Ancient Greece, 5th Century BC). It is clearly central to trust in the professional-patient consultation that the professional will not speak of what he/she has learned in a professional capacity. People would not speak frankly or honestly in a consultation if they felt confidences would not be respected. It is also clear that people must be protected from disclosures that may embarrass or upset them or possibly cause stigmatisation or harm. But things have moved on since Ancient Greece, we have a raft of procedures and legislation that our ancestors did not have to concern themselves with.
Firstly, what is medical confidentiality? A very good definition was given by Mr Justice Boreham in a 1971 case as ‘the duty not to disclose voluntarily, without the consent of the patient, information that the doctor has gained in a professional capacity, save…in very exceptional circumstances’. In other words, what is said in a professional consultation remains in a professional consultation and is not discussed more widely. However, you will see from the learned judge’s definition that there are provisos and exceptions in the area of confidentiality and we will discuss these in a bit more detail. There are three main areas, all alluded to in the above definition, where confidentiality may ethically and legally be broken –
- ‘Voluntarily’ – the law courts can compel a doctor or health professional to breach confidentiality to give evidence to the court. This is via a court order and the health professional must not disclose any more information than the court requires in the interests of achieving justice.
- ‘Consent of the patient’ – of course medical matters can be discussed with others provided that the patient has previously agreed to this. If you are happy for another person (perhaps your spouse or family member) to obtain information (eg test results) from the Health Centre, this is fine, provided you have previously agreed to this, preferably in writing. Otherwise Health Centre staff cannot give any information to anyone other than the individual patient. Slightly different rules apply to younger children (up to the age of 12 years) and to those who are unable to give consent because of illness or medical condition (in which case a health professional may discuss matters of care in the best interests of the patient, provided that the patient has not previously objected to information being disclosed). Any medical reports (eg for life assurance, employment etc) require the signed consent of the patient before they can be completed.
- ‘Save…in very exceptional circumstances’ – there are extreme (and unusual) circumstances in which confidentiality may be breached without a patient’s consent, in the wider interests of the safety of society or of an individual. For example, in one case known to me (not in this practice) a bus driver had a series of ‘mini strokes’ but refused to agree to stop driving his bus or to allow his doctor to contact his employers. The doctor informed DVLA and the employers to prevent the catastrophe of the driver being affected at the wheel of the bus and crashing the bus. In all of these situations a doctor should try and persuade the patient to agree to disclosure of medical information and at least should inform the patient that medical information has been disclosed. I would emphasise that all of these are unusual and rare circumstances.
As we have seen above confidentiality applies to children, including teenagers, when a decision must be made as to whether an individual is mature enough to make a decision regarding the management of their personal information. Confidentiality also applies to the dead, although there is the proviso that doctors are freely allowed (indeed encouraged) and able to explain the circumstances leading to a person’s death to next of kin family members. Readers with an interest in history may recall that the distinguished physician Lord Moran had his knuckles seriously rapped for disclosing medical information about Sir Winston Churchill in a book published after Sir Winston’s death.
Doctors have always had a professional duty of confidentiality but this is now enshrined in law in the Data Protection Act 1998 which sets detailed standards as to how we deal with patient data, how it is stored, and your rights to see data held about you. Medical confidentiality is also contained in Article 8 of the European Convention on Human Rights which guarantees the right to a private and family life.
At Great Eccleston Health Centre we take patient confidentiality very seriously. All staff are instructed in confidentiality principles in their induction and respect of confidentiality is an important clause in all contracts. People working temporarily in the Health Centre including medical students, have an induction in which confidentiality is emphasised. All NHS organisations have a named individual whose responsibility it is to see that confidentiality systems and processes are maintained (a so-called Cauldicott Guardian – in the Health Centre’s case this is myself). We have an annual update to refresh all staff on the principles of guarding confidentiality and further training as needed. The unlikely scenario of a deliberate breach of confidentiality would be dealt with very seriously indeed, and we remain vigilant to prevent any accidental disclosure of medical information.
I hope this explains some of the basics of medical confidentiality and how we seek to protect this at the Health Centre. If you have any concerns about information protection or confidentiality please do not hesitate to contact our Practice Manager, Anna-Marie Davison, or myself.
Dr Steve Cottam