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When can Information be Shared with Patients’ Friends and Families?

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The conflict of patient confidentiality and a doctor’s need to care

One of the big bugbears in today’s openly social world is how a doctor and practice staff should treat patient confidentiality. While people gladly air their hopes, fears, deepest secrets, and health issues on social media streams such as Facebook, a doctor is left between a rock and a hard place when deciding what can or cannot be discussed with concerned friends and relatives of patients.

After a lengthy public consultation period, and further work by a task and finish group through May, June, and July, the GMC is due to publish new confidentiality guidance during or shortly after October this year. Ahead of this, I thought I’d take a look at the type of issues that cause GP practice staff (and doctors in particular) so much angst. It’s these types of issues that the new guidance should help to address.

Damned if you do, damned if you don’t (discuss)

Two particular situations spring to mind when I think about conflict around the issue of confidentiality and friends and family of patients.

The first is where a patient is unconscious. Just what can you tell a spouse about their partner’s condition? And what about family members who call for news? I’ve been there myself (as a caller): a family member has been in hospital in a coma, and I’ve been desperate to discover progress from the other end of the country.

The second situation is when a patient’s relative wants to meet a patient’s doctor to discuss concerns about the patient’s health. A friend of mine is going through this scenario at the moment. His mother is suffering from early-onset dementia, and he wants to meet with her doctor to discuss her health. How does this fit with guidelines on confidentiality?

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When do difficult decisions become impossible?

Most people become conflicted when told a secret. For example, a friend (recently divorced) tells you in confidence that he has always had a crush on your sister. Since before they left school, the pair have been best friends. They do so much together, but no one has ever taken any notice − the friendship has always been platonic. Should you pass on your best friend’s revelation to your brother-in-law?

Now multiply this type of conflict tenfold. Examples of the conflict faced by doctors every day include:

- A patient who is not well enough to give permission for medical details to be discussed. If the doctor does or does not speak candidly to the patient’s relatives or friends, at a later stage it could be argued that the doctor revealed too much or not enough about the patient’s health issues.

- A patient whose family members disagree about who should be told what about the patient, their condition, and the care and treatment given. This is compounded where the patient doesn’t possess the capacity to have their say on the matter.

- A close friend or relative wishes to share his or her concerns about a patient’s health or lifestyle. This is particularly difficult if the patient has said that they don’t want the doctor talking to that particular person. The doctor knows that information divulged could help the patient, but is this breaking patient confidentiality?

What the GMC says about patient confidentiality

The GMC currently says that doctors should seek clarification from the patient about whom they can speak with. However, the doctor must also be sensitive to the needs of that person − this could be a tough time for all concerned.

It may be that a doctor will listen to the views and concerns of a connected party, but when doing so it should be made clear that the conversation may be relayed to the patient. The doctor may also have to take into account whether the patient would consider the doctor simply listening to the concerns of others as a breach of trust.

For more information on current best practice and guidance, see Good medical practice in action.

How do you cope in such a sensitive situation? Have you found that a one-size-fits-all approach works, or do you have to customise on a patient-by-patient basis?

Other resources:

Guidance on data sharing from the Department of Health

Guidance on disclosure ofconfidential information to third parties from the Medical Defence Union

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