This case-study looks at what the GMC guidance says about disclosing information to the police. Can you refuse on the grounds of patient confidentiality?
The scenario can be viewed as an interactive story on the GMC website here - or you can read it in full below.
Narrator: Two police officers have come to Dr Peters' clinic and asked the receptionist for a list of all the patients who attended the clinic the previous Monday. Dr Peters has come out to reception to see if he can help.
Discussion in the reception area
Dr Peters: Good afternoon gentlemen. My receptionist tells me you're after a list of the patients seen here on Monday, is that right? Do you have a court order for the release of the information?
Police officer 1: Not as yet, Doctor. We've received reports of a serious assault that took place outside this clinic on Monday night. We understand that a gang of youths were verbally abusing a young man, a Mr M in your waiting room and, when he left your clinic, this gang was waiting for him outside. They followed him to the car park where a serious assault took place, culminating in the gentleman requiring hospital treatment.
Dr Peters: I see. And do you have a description of the young man that you're looking for?
Police officer 2: Not a very detailed one I'm afraid… the main suspect's face was obscured by his hood and sunglasses but Mr M described him as mixed-race, just under 6 foot tall, late teens to early twenties, slim build.
Dr Peters: Well that could be any number of our patients. Do you realise how many people come to this clinic in a typical day?
Police officer 1: Well, Dr Peters if you can just give us the names of those patients we can check to see if any of them are already known to us, and take it from there.
Should the doctor…
a. Arrange for the list of patients to be given to the police since a serious crime has been committed?
b. Refuse to give the list to the police because it would be a breach of those patients' confidentiality?
c. Insist that the police come back with a Court Order for the release of the information?
a. This might not be in line with GMC guidance. Confidential information may be disclosed in the public interest in order to assist with the prevention or detection of a serious crime. However, the information the police are asking for in this case is extensive and sensitive: if it were disclosed the patients on the list may well be discouraged from attending the sexual health centre in the future.
b. This may be in line with GMC guidance. However confidential information may be disclosed without consent if that would be likely to assist in the prevention or detection of a serious crime, especially crimes against the person. Dr Peters needs to decide whether the benefit of disclosing the information (helping the police with their enquiries) outweighs the damage that would be done to the trust the patients on the list have in him and his clinic.
c. This may be in line with GMC guidance. However, Dr Peters could decide to disclose the information without a Court Order, provided he judged it to be in the public interest to do so. This would mean that the benefit of disclosing the list of patients (the prosecution of a serious crime) would have to outweigh the benefit of keeping the list confidential (maintaining patients' trust in a confidential sexual health service).
What the doctor did
Narrator: Dr Peters explained to the police officers that the information they were asking for was both extensive and extremely sensitive, and that patients – particularly those attending a sexual health clinic – needed to have faith that the clinic would not disclose their personal information without serious consideration. Dr Peters asked the police officers to come back with a court order for the release of the information or, alternatively, a more accurate description of the main suspect so that the search could be narrowed and the list of names reduced.
Disclosures to courts or in connection with litigation, Confidentiality, paragraphs 21-23
21. You must disclose information if ordered to do so by a judge or presiding officer of a court. You should object to the judge or the presiding officer if attempts are made to compel you to disclose what appears to you to be irrelevant information, such as information about a patient's relative who is not involved in the proceedings.
22. You must not disclose personal information to a third party such as a solicitor, a police officer or officer of a court without the patient's express consent, unless it is required by law or can be justified in the public interest.
23. In Scotland, the system of precognition means there can be limited disclosure of information in advance of a criminal trial, to both the Crown and Defence, without the patient's express consent. The disclosure must be confined solely to the nature of injuries, the patient's mental state, or pre-existing conditions or health, documented by the examining doctor, and their likely causes. If they want further information, either side may apply to the court to take a precognition on oath. If that happens, you will be given advance warning and you should seek legal advice about what you can and cannot disclose.
This case-study is from the Good Medical Practice in Action section of the GMC websiteCase study - Disclosing information to the police Case study - Disclosing information to the police Patient confidentiality: Disclosure of information to the police