Protecting patient information from improper disclosure is an essential principle of medical practice and a legal obligation but there are times where it is necessary to share information about a patient.
Although this will usually require the patient’s consent, this is not always possible, which can raise a difficult ethical dilemma.
The GMC’s new confidentiality guidance came into effect from 25 April 2017. Confidentiality: good practice in handling patient information is more extensive than the previous version and addresses some of the ethical complexities surrounding disclosure, with and without consent.
The guidance outlines four circumstances when you can disclose information without breaching your duty of confidentiality:
The guidance then looks at the different purposes of disclosure – for direct care, to protect patients and others and ‘secondary purposes’ – and provides an ethical framework and flowchart to support decision-making.
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In the first instance, you should tell your patient about any conditions or treatments that might affect their driving. Explain that they have a legal requirement to notify the DVLA about any relevant condition but if they continue to drive while unfit, you may have to disclose this information. If they disagree, you can suggest they seek a second opinion but that they should not drive in the meantime. If a patient is incapable of understanding the advice not to drive, (for example if they have dementia), then you should inform the DVLA straight away.
If a patient cannot be persuaded to stop driving and you believe they are putting other people at risk of serious harm, you would be justified in making a public interest disclosure to the DVLA.
If possible, you should tell the patient that you intend to do this and consider any objections they put forward. However, if you decide to go ahead, the GMC says you should contact the DVLA promptly and disclose any relevant medical information, in confidence, to the medical adviser. After doing so, you should notify the patient, ideally in writing and record your actions in the patient’s record.
Disclosures for secondary purposes, including those to insurers, generally require the patient’s explicit consent, unless they are required by law or can be justified in the public interest. Secondary disclosures are considered in paragraphs 77-116 of the confidentiality guidance, while disclosure to insurance companies is specifically covered by further explanatory guidance.
Many insurers will provide a patient consent declaration but if in doubt you should confirm this with the patient. It is important that they understand what information will be included in the report, the potential consequences of such a disclosure and that you may not conceal or withhold relevant information.
The patient has a statutory right to see the report under the Access to Medical Reports Act 1988 and it can be helpful to share a report in advance of disclosure, so that they have a chance to correct any factual inaccuracies. However, if the patient asks you not to disclose relevant information, explain that you cannot sign a report which you believe is misleading.