Practice dilemma - A possible case of fraud

The Dilemma: Mr Smith comes to see you as a new patient.He has moved to the area to be with his new partner, Ms Jones, who is a patient of yours and a widow. Mr Smith is seeing a therapist for cognitive behavioural therapy. His therapist contacts you to explain she had been suspicious about Mr Smith and contacted the police, and that Mr Smith is known to them under multiple aliases. He has convictions for fraud and has preyed on vulnerable widows to get their money. You are worried and feel you should tell Ms Jones about this but are concerned it would be a breach of confidentiality. What should you do?

Should a GP tell a patient about their new partner’s criminal past? (Photograph: SPL)

A GP's view
Dr Alison Glenesk is a GP in Aberdeen

This is a very difficult problem, with various courses of action you might take. Firstly, it is important to establish that the therapist and her information are bona fide, perhaps by contacting her professional organisation. A call to your medical defence organisation is also essential.

The possible courses of action are: tell Ms Jones that you have reason to believe that her friend is a conman; ask the therapist to tell her, since she has raised the problem; invite Mr Smith into the surgery to discuss the matter; or phone the police, or ask the therapist to do so.

The main issue is whether you can breach confidentiality. GMC guidance says that confidentiality can be breached to protect an individual from serious crime or disease. It says that you should tell the individual whose confidentiality is to be breached unless this might cause further difficulties, as is likely to be the case here.

Stealing and fraud are serious crimes, so you would be entitled to go ahead.

However, as this matter is likely to require criminal investigation and is not medical, I would put the whole matter into the hands of the police.

I would then prepare to support Ms Jones through a potentially traumatic period.

A medico-legal opinion
Dr Jim Rodger is head of professional services with the UK-wide medical defence organisation MDDUS

You must treat this information with great scepticism. You may or may not know the therapist and you should judge whether this is a reliable source of information.

The story that the therapist contacted the police and was given this information, does not, to my mind, ring true.

What you have is hearsay and it should not, without corroboration, be accepted as fact.

The story would concern a doctor but his prime duty is to the clinical care of his patient and not their financial or social affairs.

You are not in direct receipt of this information and since it could very well be false, you are in no position to relay it to your patient's partner.

It is not medically confidential and would not be regarded as a breach of that type of confidence if you were to tell Ms Jones.

However, to disclose this information without clear and direct evidence would expose you to possible civil action in regards to defamation.

It would be prudent to watch for any issues that arise in Ms Jones' health that might be attributed to such a scenario.

This would be particularly so if you were asked to be involved in legal matters concerning her capacity.

A patient's view
Stella Macpherson is an expert patient

The doctor is in a very difficult position as both Ms Jones and Mr Smith are his patients and he has a duty of care to them both which includes confidentiality. Ms Jones, his long-standing patient, could be in danger if Mr Smith continues with his past behaviour.

The information supplied by the therapist requires more in-depth research. The doctor should contact her to ascertain if Mr Smith engaged in any potentially dangerous activities.

It is important to assess any potential risks to Ms Jones' health and well-being. The doctor also needs to find out more about Mr Smith's background.

The doctor could ask Mr Smith about his past medical history while endeavouring to find out more about his post-traumatic stress disorder.

Spending time encouraging him to talk through his problems may allow a better insight into the situation. This may help alleviate the doctor's concerns or indicate a course of action.

If there remains a suspicion, the doctor should contact the police to find out what support they would give.

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