If you are treating a patient with a serious or long-term condition, it’s almost inevitable that you will meet their family or carers. In most cases, they will be a valuable ally in supporting your patient but you should think twice before sharing personal information with them.
The GMC’s new Confidentiality guidance is clear that the patient’s right to confidentiality should usually be respected and yet there may be times when you believe disclosure to a family member is in the patient’s best interests. The following anonymised scenarios explore some typical dilemmas raised by MDU members:
A patient with dementia
A GP was treating an elderly woman who had recently been diagnosed with Alzheimer’s disease. The patient’s husband requested a meeting with his wife’s GP because he wanted to know what he could expect regarding his wife’s prognosis and future course. He did not want his wife to attend the meeting as he thought it would upset her. However, the GP believed the patient had capacity and should be included.
The GMC says you should not refuse to listen to the views or concerns of those close to the patient on the grounds of confidentiality. The information they provide might be helpful to you in providing care (paragraph 39). However, you should consider whether your patient might view a private meeting without her as a breach of trust.
The patient should certainly be involved as much as possible in discussions about her diagnosis and treatment options and if she still has the capacity to understand, it would make sense to talk to her now about what information she is happy for you to share with her husband.
The GMC says that an early discussion about what information a patient wants you to share and with whom is ‘particularly important if the patient has fluctuating or diminished capacity or is likely to lose capacity, even temporarily’ (paragraph 36).
If you feel it appropriate, you may want to consider discussing with the patient whether her husband or another person should be given Lasting Power of Attorney so that you can share relevant information with them when the patient loses capacity.
You may decide to meet the husband without the patient being present in order to listen to his concerns and provide general information about the course and treatment of the disease. However, you should be careful not to inadvertently disclose personal information without the patient’s consent and you should make clear that you might need to tell the patient about the conversation, 'if it has influenced your assessment and treatment' (paragraph 40).
Records of a deceased patient
A GP received a request for a deceased patient’s records from the patient’s granddaughter as she wanted to make a claim against the company providing his domiciliary care. The patient had previously told the GP that he did not want his family to know about a brief spell in psychiatric hospital more than twenty years earlier.
In general terms, your duty to maintain a patient’s confidentiality persists after they have died. However, there are some circumstances when the GMC says you can disclose relevant information about a deceased patient (paragraphs 135-137).
This includes where a person has right of access to a deceased patient’s personal information under the Access to Health Records Act 1990. As the granddaughter may have a claim arising from the patient’s death, she is entitled to make an application for access to the records. However, she is only entitled to see information relevant to the claim, which in the above scenario would not include information regarding the patient’s psychiatric care many years previously.
Furthermore, the GMC states that 'if the patient had asked for information to remain confidential, you should usually abide by their wishes' (paragraph 136). In general, it is a good idea to seek guidance from your medical defence organisation if you receive this kind of request, particularly if you suspect there may be medico-legal implications.
The GMC expects GPs to be sensitive and responsive in providing information and support to those close to the patient while respecting the patient’s right to confidentiality. Effective communication with the patient is important to determine what information they are happy for you to share, particularly in a more complicated situation as when a patient is likely to lose capacity.
Any information you do disclose to the patient’s family should be relevant to the particular circumstances; you should not include irrelevant information about the patient’s medical history.
As with any disclosure of a patient’s personal information, you should clearly document what information you have disclosed, your reasons for doing so and whether this is with the patient’s consent (or the reasons why you have not sought or obtained their agreement).