We've got the surgery site but where's the money?
If a patient behaves violently does he lose the right to confidentiality, and if so how much information can the GP disclose? Dr Paul Colbrook of the MDU provides answers
Almost a quarter of GPs questioned recently by the MDU had been physically assaulted over the last two years. And two-thirds said they feared violent assault at work.
Last year, according to Department of Health figures, there were 114,000 reported violent or aggressive incidents against NHS staff a rise of 4,000 on the previous year.
In a bid to make staff feel safer
it has been reported that a number of PCTs are piloting a personal safety device which it is hoped will protect GPs and other health workers on home visits.1
Looking like a normal identity badge, the device contains global positioning tracking technology that enables a call centre to pinpoint the wearer's exact position. In a potentially violent situation the wearer can activate the tracking device and the call centre can call the police, if necessary.
The new gadget raises an important issue for doctors who are unfortunate enough to be involved in a violent or abusive incident: does a violent patient forgo his right to confidentiality and, if so, how much information can you disclose to the police or another third party?
When a patient is violent or aggressive your first priority is to protect yourself and your colleagues. The Department of Health has instigated a zero-tolerance policy to protect staff (www.nhs.uk/zerotolerance/).
But the short answer as to whether violent patients lose their rights to confidentiality is that they don't.
Everyone has a right to expect that information doctors hold about them will be treated in confidence. But the GMC suggests there may be times when a doctor may pass on confidential information without consent, or even against a patient's wishes. One of them is when a patient has attacked you or a member of your team.
But if you need to report a violent incident to the police it is important to remember that there are strict limits as to what details you can disclose.
In its booklet 'Confidentiality: Protecting and Providing Information' the GMC says confidential information may be shared without consent where the benefits to an individual or to society of the disclosure outweigh the public interest in keeping the information confidential. It states that if you are considering disclosing confidential information without consent you must weigh the possible harm both to the patient and to the overall trust between doctors and patients against the benefits that are likely to arise from the release of information.
Before considering whether a disclosure in the public interest would be justified you must be satisfied that it is not practical to anonymise the information about the patient.
Ultimately the public interest can only be determined by the courts. But the GMC may also require you to justify your actions if a complaint is made about the disclosure. The GMC says disclosure of personal information without consent may be justified in the public interest where failure to do so may expose the patient or others to risk of death or serious harm.
Even if a patient has refused to give consent, you should, where practicable, inform the patient that you intend to make a disclosure. But in a situation where a patient is violent or you fear violence, it may not always be practicable to seek consent. In circumstances where a disclosure may assist in the detection or prosecution of a serious crime for example, the GMC advises you to disclose information as speedily as possible to the appropriate authority.
Disclosures should be kept to a bare minimum for instance informing police of a name and address. It is also advisable to keep detailed documentation in the patient's records of your actions and reasoning. One of the advantages of the tracking device is that in an emergency situation on a home visit, the health care worker wearing it can be instantly pinpointed. The location of the GP may be all that is needed to be disclosed and will allow the call centre staff to alert the police or other help.
Of course, if you are aware that a patient has a past history of violence or aggression it may be more appropriate to take steps to reduce the risk, such as being accompanied by a colleague, or arranging to meet the patient in a more secure location like a police station or hospital.
This is not least because the routine activation of devices that would pinpoint a health care professional's movements, without informed consent from patients, may prove more difficult to justify if other steps could have been taken to try to prevent the violent situation.
·There are strict limits on what information you can disclose to third parties such as the police, even if a patient has been violent
·If disclosure is justified, keep the information to a bare minimum for example informing the police of a patient's name and address only
·Clinical information should only be disclosed if failure to do so would put the patient or others at risk of death or serious harm
·You may be asked to justify why you decided to disclose information by the GMC so keep a record of your actions and reasoning this is important
·If a patient has a past history of violence, it may be sensible to avoid seeing them alone or at their home
1. NHS workers fitted with tracking device, Financial Times, May 26, 2004
Paul Colbrook is an MDU medicolegal adviser