Page last updated at 09:13 GMT, Wednesday, 7 April 2010 10:13 UK

When do you break a patient's confidence?

Marika Davies
VIEWPOINT
Dr Marika Davies
Medicolegal adviser, Medical Protection Society (MPS)

If a patient presents with a sexually transmitted disease, how far do you go to protect their partner?

GP consultation
GPs must take care not to breach confidentiality

In this week's Scrubbing Up, medico-legal expert Marika Davies explores the problems that might arise from having a couple as patients.

Recent media coverage of the illicit affairs of celebrities such as Mark Owen, John Terry and Tiger Woods has focused extensively on the impact on those involved, but there can also be a knock-on effect for those in whom the cheating partner may confide.

Patients involved in extra-marital affairs often turn to their GPs for help with problems such as sexually transmitted infections (STIs), unwanted pregnancies, or simply because they see them as a confidante.

Doctors are bound by a strict duty of confidentiality, as set out by their regulatory body, the General Medical Council (GMC), but this can put them in a very difficult position, especially if they are also responsible for the care of the partner who is being cheated on.

For example, what if a patient has an STI that he has contracted through an illicit affair, about which his wife is unaware? She may be at risk, so does the GP have an obligation to inform her?

The GMC states that patients have a right to expect that information about them will be held in confidence by their doctors.

Keeping confidences

Only in exceptional circumstances can a doctor consider breaching this duty, for example where a failure to disclose the information could lead to a risk of serious harm to others.

It is clearly in the public interest for patients to be able to seek confidential medical advice and treatment, particularly in cases of communicable diseases.

One GP practice found themselves in difficulties when they received a laboratory result showing that a patient had tested positive for chlamydia.

Referring your patient to a sexual health clinic for further treatment is the best course of action, as the clinic will be able to carry out contact tracing and ensure that those who may be at risk can be treated.

Although the clinic will not disclose the identity of the patient, it may lead to difficulties for the family doctor who is confronted by an irate partner wanting to know why they have been contacted by the sexual health clinic.

In one case a woman found an appointment card for the clinic in her husband's pockets.

She demanded that her GP tell her why her husband had been referred there, and put her under a great deal of pressure to provide an explanation.

The GP handled the situation well, and advised the wife that she could not tell her anything about her husband without his consent. She also suggested to the wife that she should attend the sexual health clinic for a check-up herself.

Care needed


One GP practice found themselves in difficulties when they received a laboratory result showing that a patient had tested positive for chlamydia.

The receptionist left a message on the patient's home telephone number informing her that a prescription was waiting for her at the practice.

Unfortunately, her husband picked up the message, came to the practice and was handed the prescription along with an information leaflet on chlamydia that the GP had helpfully attached to the prescription.

There was a clear breach of the wife's confidentiality - the practice apologised and carefully reviewed its procedures.

Doctors may be uncomfortable knowing about the extra-marital activities of their patients, but confidentiality is a key part of the doctor-patient relationship
Another doctor contacted the MPS for advice about a patient who had been diagnosed HIV positive, and who was adamant in his refusal to inform his wife, despite the doctor's best efforts to persuade him to do so.


Under the particular circumstances of this case, and in compliance with GMC guidelines, the doctor considered it necessary to breach his patient's confidentiality and inform the wife, in order to protect her from a risk of serious harm.


Doctors must be vigilant even many years down the line, as the duty of confidentiality continues even after a patient has died.

A GP recently sought advice from MPS as she had been contacted by a patient asking to see his deceased wife's medical records. Reviewing the records, the GP noticed that the patient had had a termination of pregnancy 30 years ago, next to which it was documented that her husband was unaware.

The doctor was advised by MPS that she should not disclose information that the patient would have expected would be kept confidential.

Finally, spare a thought for those doctors who are responsible for the care of celebrities in the media spotlight, and who may come under intense pressure from the press or others to disclose confidential information.

Intimate details of the private lives of these patients may be splashed across the front pages, but they are still owed the same duty of confidentiality by their doctors.

Doctors may be uncomfortable knowing about the extra-marital activities of their patients, but confidentiality is a key part of the doctor-patient relationship and is essential in ensuring that the public's trust in doctors will be maintained.




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