Principles of Confidentiality
A patient's right to confidentiality has been an integral part of healthcare ethics for centuries and is highlighted in the Hippocratic Oath.

General Medical Council (UK)1:
  • Good Medical Practice (2006): "patients have a right to expect that information about them will be held in confidence by their doctors."

Useful Definitions:

Confidentiality is 'the protection of a patient's personal information or personal informed decision from unauthorised parties'. This includes a patient's name and address, not just medical information.

  • These notes will aim to take the reader through:
  • Confidentiality as a duty of care to patients
  • The Consequences of breaches in confidentiality
  • The scenarios where confidentiality is most commonly breached.
  • When should confidentiality be breached?
  • The legal and ethical aspects of the use, transmission, and storage of electronic data. (Data Protection Act 1998)
Confidentiality as a Duty of Care to Patients
Until 2000, there was no statutory duty of confidentiality in the UK - it was only an implied form of contract between the doctor and the patient. Confidentiality enables the patient to place trust in the doctor-patient relationship. This is essential for the patient to feel they are able to disclose sometimes embarrassing symptoms and undergo physical examinations.

The statutory obligation for confidentiality:

  • Article 8 of the Human Rights Act 1998:
    States "Everyone has the right to respect for his private and family life, his home and his correspondence"
  • NHS (Venereal disease) Regulations 1974:
    States that GUM clinics can only release confidential information to the patient's GP only with explicit consent from the patient (it cannot be implied)
  • Human Fertilisation and Embryology Act 1990 (1992 amendment):
    States that fertility clinics also require explicit consent before allowing disclosure of information to the patient's GP.
  • Abortion Act 1991:
    Abortions must be notified to the Chief Medical Officer
  • Misuse of Drugs Act (1971):
    Known or suspected drug addicts must be notified to the Home Office
  • Public Health (Infectious Diseases) Regulations 1988:
    Certain infectious diseases must be notified to the local authorities (i.e. TB)
  • Prevention of Terrorism Act 2000:
    Any person with information that might prevent an act of terrorism must report it to the police

Minors may wish to conceal their medical history from their parents (i.e. contraception), and if they are Gillick competent then they have a right to confidentiality. The doctor does however have an obligation to try and persuade the minor to inform his parents.

Spouses have no right of information and this includes abortions. The doctor cannot notify the police in cases of martial violence unless they have specific consent from the patient.

Medical Students
From the moment medical students start their clinical training they have access to confidential information. They are expected to have the same standards of confidentiality as qualified doctors.