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When the police arrive to demand a patient's notes

Case history

Faisal has been your patient for about six months. He is a solitary young man whose occasional comments on his thoughts and perceptions have led you to refer him to the community mental health team, but he has never seen them and has continued to see you for prescriptions and brief consultations.

Now you are on call, it is 5.45pm on Friday and the receptionists ring to tell you the police want to see you.

A senior officer demands Faisal's full history, all his addresses since registration and copies of all notes on his health.

It is a matter of the utmost national security and an emergency and the officer advises you that confidentiality is irrelevant.

What are you going to do immediately and in the next few days?

Dr Stefan Cembrowicz

'The officer is unlikely to know the minutiae of our ethical obligations'

Meeting a very assertive, grim-visaged senior police officer after hours among the lost souls of your late surgery may not be for the faint-hearted. And not all of us would be confident exactly what our legal obligations were in a crisis without the advice and support of more knowledgeable colleagues.

As far as I am immediately aware, I am obliged to break my code of confidentiality only in the most serious situations ­ in the case of murder or to protect a child. Lesser crimes cannot be disclosed if I become aware of them. In this case the patient sounds unsettled and may have some degree of mental instability, but you are not a material witness to any serious crime.

Your interrogator will need to extend his own confidentiality to you to explain exactly why he needs you to break your vow of silence, so you can judge whether the GMC rules ­ to be broken at your peril ­ must indeed be breached. Has your patient merely been involved in credit card fraud or a passport scam? Or were those flying lessons he took something more sinister than a present from a generous uncle?

You also need to know why it cannot wait until the next morning when a supported decision can be made. Your police officer is unlikely to be familiar with the minutiae of our ethical obligations. Explain he could even jeopardise his own case if he obtains confidential evidence other than through the correct channels.

You may be able to put your hands on a copy of the GMC confidentiality guidelines (among the haystack-sized pile of other guidelines that we are all expected to have to hand). Our LMC members are wise birds, familiar with most sorts of catastrophe, and someone from the LMC will probably still be doing his own evening surgery and should be able to give you advice.

Just to test the system, I phoned the GMC and my defence organisation at 5.05pm on a Friday. The GMC gave me some music and a cheery recorded message, but my defence organisation came up trumps with a 24-hour emergency helpline.

Dr Rupal Shah

'If Faisal has been arrested I would challenge the request'

Why do these things always happen on a Friday evening?

I would try to find out more from the police about the crime Faisal is alleged to have committed ­ in particular, whether his actions have endangered anyone's life.

I would need to know whether Faisal

has already been arrested, in which case I would not want to get involved at this stage.

As far as I know, I am only obliged to release enough information to help the police apprehend a patient who they suspect has committed a serious crime.

If Faisal has already been arrested, I would wait for a court order before proceeding, as I would question the need for them to have his information immediately.

At the very least, I would want to discuss it with my partners.

If Faisal has not been arrested, I would have to release relevant details to help the police with their inquiries, but I would not have to supply the details of his entire medical records.

For example, I would only release details of the possible psychiatric history if they were directly relevant to the crime. Faisal's solicitor may want this information at a later date.

I would ask the police for permission to obtain Faisal's consent first, but this request is likely to be turned down.

I would have to contact my defence body and discuss with my partners whether they had ever had any cause for concern about Faisal's mental health; this kind of information might be useful to Faisal's solicitor.

It might be worth looking through Faisal's notes from his previous GP to check for any other psychiatric history.

I would also try to contact Faisal; of course, he may well have been arrested by now.

If he hasn't, it would be important

to see him again to assess his mental

state and chase up the referral to the community mental health team if appropriate.

Dr Rachel Pryke

'I'd want as much gory detail on the alleged security risk as I dared ask'

No need to panic. My defence organisation offers 24-hour advice in emergencies, but I'm not sure I'd class this as one.

First, I would want to meet the police officer, establish clearly his credentials and the authority on which he was demanding information (plus as much gory detail on the alleged national security risk as I dared to ask).

If I were to divulge any details, I would want some authorisation in writing for my own protection. Did the police consider asking Faisal for permission to see his medical records? This simple request might make everyone's lives a bit easier.

Having established the patient is a potential national security threat, I would want further clarification about his rights to medical confidentiality. After all, he might be innocent, whatever the post

9:11 paranoia. I would try to speak to a colleague, preferably one of my partners, possibly my GP husband, or consider one of our LMC colleagues, to see if they had a clear and confident approach to divulging patient details in these circumstances.

Failing help from these sources, I would resort to the defence organisation's 24-hour advice line.

Without wanting to appear unhelpful to the police (you never know when you will need them) I would try to establish the minimum amount of information they require. Giving out past addresses would seem reasonable to me, but I would need to be confident of my ground before handing over copies of his medical records.

Another issue is my own handling of Faisal's medical problems. I would make further notes, clearly dated, on any recollections I had of his attendances, in case my management was called into question.

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