Confidentiality

This guidance covers disclosing information in adults; there is separate GMC guidance for children.

The GMC highlight the importance of a confidential medical service. However, sometimes patients are unable to protect themselves, and we may need to disclose personal information to protect their health and welfare.

I'm worried that my patient is at risk of harm abuse or neglect- Should I disclose?

Empower patients- make decisions about how to best move forward in partnership
If disclosure is required by law- You must disclose, but only the specific requested information, in the manner required by law. Inform your patient of disclosure (unless It would undermine the purpose)
Some disclosures are permitted but not required by law- these should have a legal basis
How you act will partly depend on whether this patient has capacity or lacks capacity:

	Disclosure required by law	Disclosure not required by law
Has capacity	You must disclose	Requires patient consent (if practicable)- ultimately the patient's decision unless non-disclosure puts others at risk of serious harm/death. If they refuse, find out why, inform them of the risks and refer to support groups
Lacks capacity	You must disclose	You must disclose to appropriate authority/person (unless not of overall benefit to the patient). Discuss with an experienced colleague and document if you think it's not in the patient's best interest

Can I share information to protect others/the public?

Confidentiality is in the public interest as it benefits society and individuals to seek medical care. However, this must be balanced with protecting and promoting the health of patients and the public.

Required by law	Requests for information	Disclosure not required by law
You must disclose e.g. infectious disease notification, provision of social and health care, preventing terrorism and investigation of road traffic accidents.	Take these seriously if patients pose a risk of serious harm (e.g. violent or sex offenders), and for formal inquiries, inquests and reviews	Either patient must consent (unless not practicable) or must have a legal basis

If you have already decided to disclose the information, don't request consent, instead inform them of this intention, unless not safe or practicable.

Deciding if you will disclose regardless of if the patient consents:

Would non-disclosure put others at risk of death or serious harm? - this may justify disclosure e.g.

When a victim of violence doesn't want to inform the police, but the perpetrator still poses a significant risk to others, such as children in domestic violence.
If someone keeps driving despite being told they are not fit to drive
A patient has a serious communicable disease but refuses to disclose
A patient is working despite being unfit for work and this poses a serious risk to others

You should only disclose if you decide that the risk of not disclosing is so serious that it outweighs the patient and public interest in maintaining confidentiality.

Pro-confidentiality factors	Pro-disclosure factors
Harm/distress from disclosing may cause withdrawal from care and poor health	Harm to others if not disclosed
Disclosing will reduce overall trust in perception of doctors	Benefit to others if information disclosed