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Your first... confidentiality breach

Dr Melanie Wynne-Jones advises what to do when and if you let something slip

Dr Melanie Wynne-Jones advises what to do when and if you let something slip

Doctors are all too aware of the need to maintain patient confidentiality at all times, but it's worth thinking through a disaster plan as you are likely to be extremely upset and worried if it happens.

Prevention is definitely better than cure so all members of the team should be familiar with and observe the practice's confidentiality code covering foreseeable scenarios. For example, computers should always be logged out when not in use and neither they nor paper records should be left where the public (including patients, workmen and casual visitors) can access them.

Consultations and telephone conversations should not be overheard – this needs to be considered when planning patient flows and premises construction/renovation. Discussions at reception are another potential weak point, and patients should be able to request privacy. Background noise in the waiting room such as a TV or music helps.

Anyone requesting confidential information about patients, in person, by letter or on the telephone should have their bona fides checked, and no information divulged without the patient's consent, unless covered by the Data Protection Act (for example the PCT can request certain information).

However, you are also expected to be sensitive to relatives' need to know, and to break confidentiality where it may be in the patients' best interests or the law requires you to do so. The GMC and your medical defence society can provide guidance where you are not sure.

Act quickly

If you do inadvertently breach confidentiality you have a duty to retrieve the situation immediately if you can – for example driving straight back if you have left a patient's records at their (or someone else's) home.

Or you may need to speak to the recipient of the information, stress that what they have learnt is confidential, and ask them to give an undertaking not to divulge it (but unlike you, they have no duty of care).

You will need to tell your partners or employing practice. Do this as soon as possible as you will need their support and advice. Also, the patient or someone else may tell them first, and as you may have put the practice's reputation at stake, they will need to be involved in subsequent discussions.

Telling the patient concerned

You will also need to tell the patient what has happened, tell them what steps you have taken to rectify the matter and offer an apology.

Patients are often surprisingly understanding and forgiving, especially when there has been a true accident and little harm has been done. On the other hand they may justifiably be very angry and distressed, especially if the breach may have serious consequences.

You should therefore ring your defence society first, if possible, to clarify your position and for advice on what you should say and do.

If you are lucky you will escape without a formal complaint, but you and the practice should carry out a significant event analysis and make any necessary changes to prevent it from happening again.

Dr Melanie Wynne-Jones is a GP and trainer in Marple, Cheshire

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