Patient confidentiality and safety: a classic conundrum
Abstract
Paramedics frequently have to balance patient confidentiality and patient safety. Patient information is subject to legal, ethical and professional obligations of confidentiality and should not be disclosed to a third party for reasons other than healthcare, without consent. Whilst there is an imperative to preserve the professional/patient relationship, there are occasions where this is not possible. This article considers circumstances when confidential patient information may be disclosed without the consent of the patient and discusses the legal, ethical and professional aspects of decision making in this context. A clinical example from practice is presented where an ambulance crew was called to a 50-year-old man with type I diabetes, which is normally well controlled with insulin. He is employed as a van driver, but has experienced two sudden hypoglycaemic episodes in 3 weeks rendering him unconscious. Once treated, he declines transport to hospital, any onward referral or to inform the Driver and Vehicle Licensing Agency (DVLA) through fear of having his driving licence suspended.
Confidentiality in healthcare has its origins in the Hippocratic Oath (Jackson, 2013) and appears in professional codes including the Health and Care Professions Council (HCPC) Code of Conduct, Performance and Ethics (2012a). Concepts of confidentiality and information sharing are well established in health and social care but there can be difficulties in practice (Health and Social Care Information Centre [HSCIC], 2013).
Everyone using the National Health Service (NHS) should expect that their medical information is treated in confidence and that they can speak openly about their health knowing that it will not be disclosed (HSCIC, 2013). We need to acknowledge however, the differing individual views and expectations around confidentiality amongst service users. One study that looked at the meaning of confidentiality found that whilst patients share an understanding that confidentiality is protection of information, there were differing views on what medical information was classed as confidential and when this information could be shared (Jenkins et al, 2005). Though a small qualitative study of 85 women in one urban region of America, it does highlight an important issue around levels of service-user knowledge and expectations.
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