The duty of confidentiality extends to you as a medical student. Here we explore the moral and legal issues involved in the sharing of confidential medical information.
Why confidentiality is important
Confidentiality is central to the development of trust between doctors and patients. Patients must be able to expect that information about their health is kept confidential unless there is a compelling reason that it should not be. There is also a strong public interest in confidentiality as individuals who need treatment will be encouraged to seek treatment and to disclose information that is relevant to it.
In order for you to develop clinical skills during your teaching, at some point you will need to have access to confidential information about patients. It is important to recognise that the duty of confidentiality extends to medical students.
Where you are present at teaching sessions involving patients, where you are shadowing practising doctors or where you gain access to confidential information in other ways during your teaching, the duty applies.
What information is confidential
All identifiable patient information, whether written, computerised, visually or audio recorded, or simply held in the memory of health professionals, is subject to the duty of confidentiality. This includes:
- any clinical information about an individual’s diagnosis or treatment
- a picture, photograph, video, audiotape or other image of the patient
- who the patient’s doctor is and what clinics he or she has attended
- anything else that, directly or indirectly, might lead to identifying the patient.
What does the law say?
"A duty of confidence arises when confidential information comes to the knowledge of a person…in circumstances where he has notice, or is held to have agreed, that the information is confidential…"
Lord Goff. Campbell v MGN Limited  UKHL 22
When confidential information can be disclosed
The duty of confidentiality is not absolute and confidential information can be disclosed where:
- the patient has the capacity to consent and consents to the disclosure
- it is required by statute, such as in relation to certain communicable diseases
- it is required by a court order, or
- it is justified in the public interest.
Food for thought
Morally, the obligation to keep patient information confidential is linked to a respect for patient autonomy. The ability to manage our private information is linked to our ability to exercise control over our lives.
When confidential information can be disclosed in the public interest
Confidential information can be disclosed without consent where the public interest in the disclosure is sufficiently strong. These can include disclosures that are essential to prevent a serious and imminent threat to public health, national security, the life of the individual or a third party, or to prevent or detect a serious crime.
Any disclosure must be both necessary: the goal cannot be achieved without it; and proportional: only as much information as is necessary to achieve the goal should be disclosed.
What’s the moral problem?
Can information be disclosed to the police without consent?
Several interests are engaged here. There is a strong public interest in a confidential medical service; there is also a public interest in tackling crime. We all have a personal interest in our private health information being kept confidential. These interests have to be weighed on the basis of an assessment of the facts of the individual case.
As with all other requests for information, the presumption would be that confidential information should only be disclosed to the police where the patient has given explicit consent. Exceptions to this would be where there is a court order requiring disclosure, where the public interest in preventing or prosecuting a serious crime outweighs the individual’s right to confidentiality or where someone is at risk of death or serious harm.
Corridor conversations and inadvertent breaches of confidentiality
During your training, you will come across a wide range of fascinating case studies. Inevitably, the temptation to discuss them with fellow students and colleagues can be strong. Health information about identifiable patients is confidential. You must therefore take great care in ensuring that you do not disclose such information to friends or colleagues unless, in the case of the latter, they are directly involved in the provision of care to the patient.
Doctors disclosing confidential information during informal conversations in public places such as lifts and train carriages have been subject to strong criticism by their regulatory body the General Medical Council for breaches of confidential health information.
A helpful concept when considering sharing information with those involved in caring for the patient is 'no surprises'. In brief, this means that patient information should be shared in ways that patients can reasonably expect. Their information should not be shared in ways that patients would be surprised to learn about.