CONFIDENTIALITY Johnny

Hi guys, I just put this slide in, just in case anybody does use this. The first 2 slides and the last 1 have information on them. Then the middle slides are a lot of practice examples. Some of these are really difficult (i.e. adapted from a 4 th years SJT practice book) – they’re more for you to challenge yourself with. Even if you find yourself struggling you’ll be able to use common sense to get an answer. Learn your pink. Its seriously easy marks.

When can you break it? When given permission When its in the public interest – Non-disclosure puts others at risk. Risk must be real, immediate and serious Statutory duty to disclose: Criminal activity Births and Deaths Infectious disease control Driving Child Abuse Abortions

32-year old man, presents with severe fever, chills, productive cough and muscle aches. Recent travel history to Philadelphia. You suspect Legionnaire’s Disease A notifiable disease. However at this stage it is only a suspicion. So, no.

20-year old student, known to be sexually active, measures positive for HIV on a routine check. Follow-up investigations confirm the diagnosis of HIV No. HIV is not a notifiable disease.

During a follow-up appointment: Whilst giving the patient information about safe sex, he admits he doesn’t use a condom, and he hasn’t told his girlfriend he is HIV+ Once the patient is aware of his diagnosis, he is criminally liable for transmission. In this case, the GMC states you can disclose to the partner without consent The patient’s girlfriend is at risk of serious infection

After becoming a Doctor (congrats.) you’re working on the stroke ward, you discharge one of your patients and advise her she shouldn’t drive for a little while. However, she disagrees with you, and when you see her a week later she informs you she has been driving Strokes do not require formal notification to the DVLA. What should you do instead? Ask them to get a second opinion What if they keep ignoring you? Then you should notify the DVLA, after telling the patient what you’re going to do Strokes/TIA, ACS don’t require formal notification to the DVLA (just advice about a period off driving) Things that do require notification: epilepsy/seizures, diabetes mellitus, acute psychosis, alcohol/drug abuse

One of your patients, a 14-year old girl, is diagnosed with cancer. You first break this news to the parents, who inform you that they do not want her to know. What do you do? You should explain to them that you should assess the capacity of the child and deliver information in a way they can understand. (Children and young people usually want to know about their illnesses. You shouldn’t withold information unless the patient refuses knowledge of that information Give me some exceptions: The information would cause “serious harm” The child specifically requests that someone else makes the decisions for them

In GP-land: a 15-year-old girl visits you asking for contraception. Do you tell her parents? In this case, realistically –no. Its all about the patients competency. Think Gillick-Fraser guidelines These are all about trying to identify abuse btw.

In GP-land: a 15-year-old girl visits you asking for contraception. However, she is visiting with her 35- year-old partner Do you tell her social services? In this case, realistically –yes. The GMC says you should consider sharing information are where: a big difference in age is ringing alarm bells

In GP-land: a 17-year-old girl visits you asking for contraception. However, she is visiting with her 21- year-old partner, her art teacher Do you tell social services? In this case, realistically –yes. The GMC says you should consider sharing information when: The partner is in a position of trust The full list where the GMC says you should consider sharing information: The young person is too immature to understand The child is under 13 A big difference in age is ringing alarm bells The partner is in a position of trust There is a force/threat suggesting emotional,psychological or physical pressure Drugs/Alcohol are involved

For a Bonus Point: Where is most Dr- Patient confidentiality breached? 1. In a lift 2. In the canteen 3. In A+E departments 4. Through leaving patients notes open 5. In pubs and restaurants

Capacity To have capacity the patient must be able to do all of the following: Understand the information relevant to the decision Retain the information Use the information as part of the decision making process Communicate their decision