Confidentiality quiz. (MPU)
Death certification A 43 year old patient died of an infarct recently. You know that he had HIV and believe that it contributed to but did not directly cause death. Because you believe that this knowledge would be very distressing to the relatives of the deceased, is it permissible to omit the HIV condition from the death certificate? No; this is relevant information and should be included in the certificate as you believe it may have contributed to the death.
Death Does the obligation to respect patient confidentiality extend beyond death? Yes in general, exceptions being related to identification and terrorism etc
Employment You’ve just appointed Joyce as a cleaner in the practice. She has no patient-care responsibilities. Should you get her to sign a confidentiality clause in her employment contract? Yes; as though she should not have patient care or access this is not a guarantee that she will not see things that should be kept confidential.
Public interest Zoe is hepatitis antigen positive. You know that her partner, who is also patient of yours, is not aware of this. She has not given consent for you to divulge this information, but acting in his interest, are you sanctioned to do so anyway? Your duty is to do your best to ensure that she does the sharing of information rather than you if at all possible. If you have tried this and still do not succeed then you are allowed to share this information and should inform her that you will have to do this if there is a significant risk to him ( as in this case).
Staff To meet the demands of the new contract, you have employed a “temp” to gather data for practice administration. Because patient consent has not been obtained to gather this data, should the patient records first be anonymised by a member of the healthcare team? The practice should try to anonymise the data, if at all possible. The GMC does allow access for epidemiological purposes when this will not affect the patient individually but best practice is to attempt anonymisation
Sexual history In the absence of patient consent, the GU department will only inform GPs of the patient’s attendance if treatment has been given. Is this true? GU departments only inform GPs if the patient has consented, Traditionally this is more likely if the GP writes a referral letter Giving or not giving treatment is not the issue.
Children: Which (if any) of these is correct? :- Under the Family Law Reform Act 1969, children aged 14 and over should enjoy the same rights to confidentiality as adults over consent to medical treatment. Over 16 under this law.. (NB The situation is also affected by the Gillick ruling which suggests that the competence of anybody under 16 should be assessed, and the individual encouraged to inform and discuss with their parents if possible; if this is not possible then consent may be given under 16 to the limits of competence of that child ) Kate’s natural parents were married at the time of her birth and continue to be so. Because of this, are you sanctioned to disclose all information about Kate to either natural parent without the other’s authority? Simply , Yes! Susanna's parents were married when she was born but later divorced. Therefore, only her mother has automatic parental responsibility and the mother’s authority is needed before information is disclosed to the father, unless the father has parental responsibility either by agreement with the mother or by a court order. Is this true? When the parents are separated or divorced, information may still be disclosed to either parent irrespective of who has custody, unless a court has removed parental responsibility from one or the other. If the parents were unmarried at the time of the child’s birth, only the mother has automatic parental responsibility. Her authority is needed before information is disclosed to the father, unless he has parental responsibility either by agreement with the mother or by a court order.
Mental illness Tony, aged 23, has schizophrenia. Despite his mental illness, is it true that he has rights to confidentiality unless he is detained under the Mental Health Act? Yes
Access to records A complaint has been made about your ex-partner concerning an incident that occurred several years ago. Your partner has not been involved in the patient's care for some years and would like to see the medical records. As she is bound by the rules of confidentiality, may she see the patient’s records without first seeking patient consent? No need for patient consent first here, as no clinical need
Police One of your patients came to surgery a week ago with lacerations to his forehead. He said that he had crashed his car the previous night. You have now been approached by the police who tell you that they know you treated this man and they want his name and address. You have told them that you cannot release any information about the patient without patient consent. Is this correct? Under the road traffic act 88 they have a right to the name and address but no more, unless authorised by a court If there is a risk of serious crime or terrorism then the police have rights to all information.