When could it be justified that one shares confidential patient information

Although the patient often assumes confidentiality, there do appear to be contradictions in its application. Obviously with the relevant patient's expressed consent a doctor can safely share confidential information in appropriate circumstances. There are specific professional guidelines laid down by the GMC as to when it is right to disclose information concerning individuals and their care. Included in the document is the guidance on disclosing information in the public interest: 'in cases where patients withhold consent, personal information may be disclosed in the public interest where the benefits to an individual or to society of the disclosure outweigh the patient's interest in keeping the information confidential' (GMC 2004). The guidelines therefore suggest that doctors can, when it is proved necessary, breach the duty of confidentiality to their patient.

Examples of breaching confidentiality can be seen in other case law concerning breaches of confidence, and may be useful when drawing comparisons. In the case of W v Egdell (1990) cited in Staunch and Wheat (1998, p. 239) a secure hospital prisoner made an application for transfer to a regional unit; this was considered to be a step towards discharge. His legal team sought the opinion of a psychiatrist to support the application. In the opinion of Dr Egdell the patient was considered dangerous, and as a result his application was withdrawn. Soon after, his case was up for an automatic review under s79 of the Mental Health Act 1983. Dr Egdell, on realising that his report was commissioned by the legal team but might not be included in the patient's medical notes, forwarded his report to the Home Office and the hospital's medical director.

The patient in question brought a case against Dr Egdell alleging breach of confidence. The court upheld the breach of confidence on the grounds of protecting the public interest, and the patient failed in the first instance and subsequently appealed. The court of appeal 'unanimously confirmed the trial judge's decision to dismiss the action but did so with rather more reservation' (Mason et al. 2002, p. 246). Further consideration was such that patients such as 'W' should enjoy the same confidence as other members of the public in order to 'bare his soul and open his mind', and that anything less would be 'contrary to the public interest'.

On consideration of the case the author would argue that Dr Egdell clearly breached the concept of confidentiality between himself and 'W'. This breach of confidentiality is clearly a paternalistic practice on the part of the medical practitioner. This is given as an extreme example of a situation where the need to protect the public directly overrides the right to confidentiality of the individual. The court of appeal rightly expressed concern as to the rights of 'W', and balanced them against the greater good and the public interest. It should be only with great caution that practitioners actively breach confidentiality, because, once information regarding a patient is made public, the damage to the individual is done, and is often irreversible. What has been told cannot be untold or retracted.

There appear to be times when it is important that we reinforce to patients the confidential nature of our services in order to provide a safe service and improve the health of individuals and the public at large. However, on exploration it becomes apparent that the confidentiality promised isn't always guaranteed. In the light of the growing number of individuals being found guilty of knowingly passing on HIV, professionals in sexual health are faced with the dilemma: how confidential is our promise of confidentiality?

The arguments to maintain patient confidentiality are strong and robust, and any practitioner faced with a situation in which they feel a strong argument to breach confidentiality should proceed with caution. Wide discussion within the service and advice from relevant legal departments or professional bodies is required to support any decisions to proceed.

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