Students should be able to demonstrate in practice an understanding of:

• the concept of confidentiality and its legal, professional and ethical bases
• when it is legally, professionally and ethically justifiable or mandatory to breach confidentiality
• how to share confidential information within clinical teams appropriately
• legal and ethical aspects of the use, transmission and storage of electronic data
• good practice in sharing information with relatives and carers and recognition of potential ethical and legal tensions.

General

BioCentre Academic Paper search

Books

Tolstoy, L: Death of Ivan Ilych, White Crow (2011)

Cover image used with permission of White Crow Books, www.whitecrowbooks.com. 

Can be used for understanding the relationship between provision of information, therapeutic privilege and confidentiality. Leo Tolstoy's novella The Death of Ivan Ilyich begins shortly after Ivan Ilyich's death. A small group of legal professionals, court members, and a private prosecutor have gathered in a private room within the Law Courts, and while looking through a newspaper one of them reads the following: “Praskovya Fedorovna Golovina, with profound sorrow, informs relatives and friends of the demise of her beloved husband Ivan Ilyich Golovin, Member of the Court of Justice, which occurred on February the 4th of this year 1882. The funeral will take place on Friday at one o’clock in the afternoon.”

Immediately members of the group begin to think how Ilyich's passing will affect their positions and status; They thank God it didn't happen to them and ponder on the implications of how they might benefit from their colleagues demise, each one of them oblivious of the fact that death will come to them all. (Amazon).

Films and documentaries

Patient interview: HIV disclosure, discrimination and other challenges

In this clip (read by an actor), from healthtalkonline.org, the patient describes how hospital staff outside the HIV clinic told his GP about his HIV status. The patient comments on how he is now reluctant to talk to health professionals. This clip is useful for discussing the medical and ethical purposes of confidentiality, such as the consequences for long term trust in doctor-patient relationships if confidentiality is breached.

Copyright © 2011 University of Oxford. Used under licence from DIPEx. All rights reserved.

Professional guidance

Confidentiality and disclosure of health information toolkit, BMA (2009)

Statement on information sharing in relation to sexually active young people, BMA (2009)

Confidentiality, GMC (2009). Includes case studies and supplementary guidance on:

• reporting concerns about patients to the DVLA or the DVA
• reporting gunshot and knife wounds
• disclosing information about serious communicable diseases
• disclosing information for education and training purposes.

Interactive case studies: waiting room 3 (Sarah, Marlena, Jacquie), GMC

Interactive case studies: waiting room 4 (Mr Jessop), GMC

Interactive case studies: waiting room 5 (Adrian), GMC

Virtual Patient Cases:

Brenda Williams and Costas Arroryo VPs: http://www.elu.sgul.ac.uk/iethics/?page_id=289

Medical Protection Society guidance

Factsheet: Access to health records

Factsheet: Access to medical reports

Factsheet: Communicating with patients by fax and email

Factsheet: Confidentiality: general principles

Factsheet: Confidentiality: disclosures relating to patients unable to consent

Factsheet: Confidentiality: disclosures without consent

Factsheet: Confidential disclosure/whistleblowing

Factsheet: Communicating: text messages

Factsheet: Consent: the basics

Factsheet: Reporting gunshot and knife wounds

Medicolegal booklet: Guide to medical records

GP Registrar magazine: Confidentiality

Department of Health publications

Confidentiality: NHS Code of Practice (2003)

Confidentiality: NHS Code of Practice - supplementary guidance: public interest disclosures (2010)

Guidance for access to health records requests (2010)

HIV-infected health care workers: Guidance on management and patient notification (2005)

Best practice guidance for doctors and other health professionals on the provision of advice and treatment to young people under 16 on contraception, sexual and reproductive health (2004)

R (Axon) v Secretary of Health and FPA [2006] EWHC 37 (Admin)

Articles

Breaching confidentiality to protect others, UK Clinical Ethics Network

B Dolan, Medical records: Disclosing confidential clinical information Psychiatric Bulletin 2004 28: 53-56

M McGilchrist, F Sullivan, D Kalra, Assuring the confidentiality of shared electronic health records, BMJ 2007; 335: 1223

D J Mole, C Fox, G Napolitano, Electronic Patient Data Confidentiality Practices Among Surgical Trainees: Questionnaire Study, Ann R Coll Surg Engl. 2006 October; 88(6): 550–553

R Elias, Confidentiality and consent in living kidney transplantation: is it essential for a donor to know that their recipient has HIV disease? Clin Ethics, December 2009; 4: 202 – 207

J Miola, Owning information – anonymity, confidentiality and human rights, Clin Ethics, September 2008; 3: 116 - 120

A Slowther, Truth-telling in health care, Clin Ethics, December 2009; 4: 173 - 175

J Fraser, Ethics of HIV testing in general practice without informed consent: a case series, J Med Ethics 2005;3: 698-702

J Bridgeman, Young People and Sexual health: Whose rights? Whose responsibilities? Med Law Rev (2006) 14 (3): 418-424.