Consequences of breaching confidentiality
  • Breaching confidentiality fails to respect patient autonomy.
  • Violation of patient confidentiality is a form of betrayal.
  • Patients have a right to confidentiality that has frequently been demonstrated in common law and in some specific areas outlined in statute law.

If a patient thinks that a doctor has wrongly breached confidentiality, they are able to pursue their grievance in a number of ways:

  • Disciplinary proceedings with the GMC: Can be struck off
  • Civil proceedings: Pay patient compensation
  • Criminal proceedings

If a doctor is found to be guilty they can be charged in court with breaking the law on confidentiality. As a result they risk being 'struck off' the GMC register (and this has happened to many doctors in recent years). Medical students in turn risk expulsion from their medical school.

When is confidentiality commonly breached?
Patient confidentiality can be unintentionally breached very easily. The Medical Protection Society (MPS) have provided a list of common situations where such breaches can occur:

  • Lifts and Canteens: Discussing information in, small, or crowded places always carries a risk. Caution needs to be taken whenever discussing confidential information.
  • A&E departments and Wards: These are areas where there may be many people, especially relatives and friends, who are in close proximity to health-care professionals discussing information about a patient.
  • Patient Notes: These are often left in an area with open access, e.g. on the receptionist's desk where other patients and visitors can see them.
  • Computers, faxes, and Printers:
    • It is very common for patients to see personal information about other patients on faxes or print-outs which have not been filed away promptly. Additionally, when sending sensitive information via a fax machine or printer, it must be ensured that the receiving machine is in a secure place where only those authorized can have access to them.
    • An even more frequent scenario is when during the course of a clinic or during the course of a ward round a computer screen bearing a previous patients details becomes visible to the next patient to be seen.
When should confidentiality be breached?
Confidentiality, although as demonstrated is a clear right of patients, it is not absolute. There are some instances where doctors are obliged to breach confidentiality and other circumstances where there would be considerable defense if the doctor felt it was in the patient's or the public's best interests to breach confidentiality.

  • When the patient gives consent
  • Sharing clinically relevant information with other staff to assist in the management of a patient. However if the patient refuses consent to share sensitive information i.e. HIV status to the GP the hospital doctor should respect that wish but should try and encourage the patient to tell his GP. Since the GP would not be placed under risk in normal conditions.
  • Sharing information to family members: If patient specifically requests that family members are not told then their wishes should be respected (unless it is a notifiable disease). Rarely, disclosure to 3rd parties may be justified if telling the patient would be injurious to his health (i.e. terminal disease notification)
  • Doctors must inform the local officer of communicable disease control if their patient has a notifiable disease e.g. TB, meningitis etc. Full list see the health protection agency guidance3. This is a statutory duty even if the doctor must breach confidentiality.
  • Doctors may breach confidentiality if there's a risk of serious harm to others - Common law: W vs. Egdell 1989.

    W a psychiatrist released a negative report about a paranoid schizophrenic's (who had previously killed 5 people) mental state - claiming that he was not safe to be released. Egdell's legal team withdrew W's report, but W in the interest of further treatment sent a copy to the hospital in which Egdell was residing. Egdell then claimed a breach of confidentiality by W, which was dismissed by the court. Thereby setting precedent that doctors could breach confidentiality in the interests of public safety.

  • Disclosure to the DVLA
  • Disclosure under the Data Protection Act 1998
  • Adverse drug reaction information along with patient details to be given to the MHA (Medicines Control Agency)
  • Doctors in private practise may disclose information to tax inspectors but every effort must be made to separate medical and financial information (i.e. bills)