Confidentiality in Primary Care: Ethical and Legal Considerations

Abstract

GPs face particular challenges in relation to confidentiality for a variety of reasons. Information about one patient may be relevant to another family member who is also the GP's patient. GPs provide continuity of care for their patients not only over time but also across multiple illnesses, minor and major. They are more likely to be aware of the social dimension of their patients' lives, for example, to know if their patient with epilepsy is driving. The GP patient record is displayed on the computer screen during a patient consultation and is visible to anyone who has accompanied the patient without the patient necessarily realizing it. These and other examples illustrate why GPs need to be aware of the ethical and legal requirements governing patient confidentiality and its implications for their work in day-to-day practice. This article describes the ethical and legal framework within which health care professionals discharge their duty of confidentiality and looks at recent General Medical Council (GMC) guidance and its practical implications.

Ethicality and confidentiality: is there an inverse-care issue in general practice ethics?

“…It has been identified as a core feature of general practice. 11,12 It is of particular interest as it sits at a convergence of professional, philosophical and legal principle: a theoretical basis for confidentiality can be justified in terms of deontology (we have a duty to respect autonomy), consequentialism (if doctors keep confidences, patients trust doctors and disclose more relevant details), virtue ethics (virtuous doctors are sensitive and respectful and therefore keep their patients' private details confidential) as well as other ethical theories. On a professional level, the UK General Medical Council asserts that 'Patients have a right to expect that information about them will be held in confidence by their doctors', and 'Confidentiality is central to trust between doctors and patients'.…”

“…On a professional level, the UK General Medical Council asserts that 'Patients have a right to expect that information about them will be held in confidence by their doctors', and 'Confidentiality is central to trust between doctors and patients'. 11,13 The legal basis has been described as a public interest duty, but is protected by both the Data Protection Act 1998 and article 8 of the European Convention on Human Rights.…”

“…These and other examples illustrate why GPs need to be aware of the ethical and legal requirements governing patient confidentiality and its implications for their work in day-to-day practice. 11 Some examples of confidentiality cases (actual and hypothetical) raised by participants † Whether to keep the confidentiality of a 'slave' whose 'owners' held her passport and beat her, but feared loss of her otherwise good lifestyle and her life if she went to the authorities; † Whether to keep the confidentiality of a patient whom police suspected of a serious violent crime -police requesting information in order to secure a conviction; † Whether to respect the confidentiality of woman suffering repeated significant domestic abuse, who did not wish to call the police; † Whether to alert the police to local drug dealing described by drug users during the consultation; † Whether to divulge confidential medical details to carers or family members of a patient with diminished capacity; † Divulging sensitive information on behalf of a patient when confidentially could no longer be realistically maintained; † Whether talking to a qualitative researcher was in breach of confidentiality.…”

Should ethics consultants help clinicians face scarcity in their practice?: Figure 1

“…Resource allocation at the institutional level certainly has some impact on the frequency with which physicians encounter scarcity,24 and is value-laden to a greater extent than is sometimes realised 46. Were they to take on a more explicit advisory role in resource allocation at the institutional level, ethics consultants could thus contribute to reducing the scarcity-related ethical difficulties encountered by physicians.…”

Screening for sexually transmitted infections in high-risk groups

“…Some of this increase can be explained by improved access to sexual health services, increased community-based testing and the use of more sensitive screening tests thereby improving the number of STIs that are diagnosed and therefore treated. However, an increase in unsafe sexual activity has also contributed to greater transmission rates of STIs (Sonnenberg et al, 2013 The key components of a comprehensive sexual history are listed in Box 1. Some patients may be embarrassed to discuss sexual history and fear judgement or stigma; therefore, it is important to use advanced communication skills during consultations to maintain rapport.…”