GMC Guidance:

• Confidentiality is central to trust between drs and patients; however appropriate information sharing is essential to efficient provision of safe effective care for patient and wider community
• Disclosure may be justified if failure to disclose may expose others to a risk of death or serious harm. Should always seek patient’s consent however
  • This is particularly pertinent if others remain at risk especially children
  • You should inform the patient before doing so if practicable and safe, even if you are going against their consent
• Knife crime: inform the police quickly whenever a person arrives with a gunshot wound or an injury from an attack with a knife, blade or other sharp instrument
• Should make a professional judgement about whether disclosure of personal information about a patient including their identity is justified in he public interest
• The police are considering
  • Risk of further attack
  • Risk to staff, patients and visitors to the ED (eg during the troubles sometimes paramilitaries would send members to finish their victims off…)
  • Risk of another attack near to or at the site of the original incident
• Don’t usually need to disclose personal information in the initial contact

 

Disclosing without consent

• If the patient is unable to consent, information can be disclosed if it is justified in the public interest eg.
  • Failure to disclose may put the patient or someone else at risk of death or serious harm
  • Disclosure is likely to help in the prevention, detection or prosecution of a serious crime
• If there is any doubt a decision can be made in conjunction with the consultant in charge or the trust Guardian
• Should tell the patient that you have disclosed to the police unless you believe that this will put you or others at risk or will undermine the purpose of the disclosure
• Document in the notes
• If not public interest, don’t disclose – police can seek an order from a judge or a warrant
• Should document if further investigation is required eg if are fit to hold a firearms license

Children – if arrive with gunshot or knife would will trigger appropriate child protection concerns and management

 

Also need to be aware of children in DV incidents

Disclosures required by statute

1. known or suspected case of certain infectious disease
2. regulatory bodies with powers to access records as part of duties to investigate complaints, accidents or health professional’s fitness to practice
3. Should try to get consent where possible

 

Disclosures to court

• if ordered by a judge or presiding officer, but only if relevant – if not about specific case (i.e. about a relative) can object
• Should not disclose without patients’ express consent unless required by law or justified in public interest

 

Disclosures about patients who lack capacity

• make care of patient first concern
• respect the patient’s dignity and privacy
• support and encourage the patient to be involved in decision
• Also consider if lack of capacity is permanent or temporary
• consider previously expressed preferences
• any legal/power of attorney
• views of relatives
• what the rest of the healthcare team feel
• May need to share personal info with relatives but should only share what is strictly necessary

Disclosures if patient is a victim of neglect or abuse

– if patient lacks consent should share

 

MPS factsheet

• should tell the patient you are disclosing where possible
• should not disclose info about an identifiable 3rd party who is not a healthcare professions

 

Disclosures required by statute

• NHS counter fraud
• Disclosures to GMC
• Coroners investigations
• Courts or litigation – see GMC guidance

 

Disclosures to protect the patient or others from harm

• serious communicable disease
• reduce risk of death or serious harm to patient or third party
  • g. because of gunshot or knife wounds
  • NB document, seek advice

 

Reporting to the DVLA

 

DVLA and DVA are largely responsible for deciding if a person is medically unfit to drive

DVLA publishes an extensive list, however their medical advisors are also available for advice if this is required

You should inform the patient that the condition may affect their ability to drive and that they have a legal duty to inform the DVLA about the condition. If the patient is uncapable of understanding, the DVLA should be informed immediately

If the patient continues to drive and you are unable to persuade them to do so, or if you discover they are driving, you should contact the DVLA. However you should inform the patient of your decision.