Wednesday, June 16, 2010

Doctors to break confidentiality

I was disturbed to see the news that doctors are to be given leeway to break patient confidentiality. The BMA has agreed with the police to share patient information where gun owners suffer from mental health problems.

I'm uneasy about this on a number of levels, whatever benign thinking lies behind the idea.

In general there has been a lack of knee jerk responses to the Cumbria shootings from the political establishment, despite the fact that the press felt unable to stop itself from page after page of unseemly rubber necking coverage for day after day. This proposal however could have serious implications.

The BMA has said that "Where doctors know that a patient has a firearm and, in their view, as a result, presents a risk of harm to themselves or others, both legally and ethically, this information can be disclosed without consent."

Part of this new move means that the gun ownership register will be linked up (in some way) to patient records where all medical records of gun owners will be 'flagged'.

There are two key problems with this in my view. Firstly, it could well prevent gun owners from seeking help from their doctor, actually increasing the probability that they will pose a future risk to themselves or others. If the consequence of having mental health problems will be that police officers, who are not properly trained in these issues, are informed that you are a public risk it's a fairly large disincentive from telling your doctor about your problems, not to mention the unpredictability of the actual response of the police when given this information.

The intention may be that doctors only inform the police in the clearest possible circumstances (although this is not explicitly stated) but it is introducing an onus upon doctors to correctly identify when mental health issues are likely to lead to murder or suicide and when they will not - which is a heavy and impossible responsibility.

The second point is that many services find it difficult to get people to come forwards and give confidential information. A slippage in confidentiality creates a problem for every service that relies on the public having absolute confidence that information they give will go no further because it means that there is a redefinition of our terms taking place.

Confidentiality ceases to be an absolute, where a patient or service user can confide information without things going any further, and turns it into a grey area where, generally, no one will be told but sometimes they will be. That's socially dangerous and could well undermine the ability of the mental health services to do their job.


Jay said...

Hi Jim,

I'm not sure what is changing, other than giving doctors access to the database of gun licence holders and applicants.

Your conclusion in bold is inaccurate. Doctors, lawyers, or anybody who is the recipient of confidential information, know that it does not extend to keeping quiet about risks of serious harm.

If a doctor believes there is a strong likelihood that a patient is about to murder his wife / go on a killing spree / blow up Birmingham, they have a duty to disclose that information.

There may be cases where a doctor might be unsure whether a patient poses such a risk but, upon discovering the patient has a firearm, decides that they are a risk.

Jim Jepps said...

I went and checked the GMC guidelines on confidentiality which said, among many other things, this;

"Personal information may, therefore, be disclosed in the public interest, without patients' consent, and in exceptional cases where patients have withheld consent, if the benefits to an individual or to society of the disclosure outweigh both the public and the patient's interest in keeping the information confidential."

So actually you're right that there is already the provision to break confidentiality.

I think there is still a significant change though in that a) the data bases will be linked in some way and b) there will now be an onus on the doctors to predict the likely outcomes of a gun owner's mental health problems.