(Circumstances in which disclosure may occur without consent)
Although confidentiality is an important duty, it is not absolute. You can disclose personal information if
- it is required by law
- the patient consents (either implicitly for the sake of their own care or expressly for other purposes), or
- it is justified in the public interest.
As a general rule, you should seek a patient’s express consent before disclosing identifiable information for purposes other than the provision of their care or local clinical audit, such as financial audit and insurance or benefits claims. Disclosures should be kept to the minimum necessary. Anonymised or coded information must be used if practicable and if it will serve the purpose.
Various regulatory bodies have statutory powers to access patients’ records as part of their duties to investigate complaints, accidents or health professionals’ fitness to practise You should satisfy yourself that any disclosure sought is required by law or can be justified in the public interest. Whenever practicable, you should inform patients about such disclosures, even if their consent is not required.
You must disclose information if ordered to do so by a judge or presiding officer of a court. You should object to the judge or the presiding officer if attempts are made to compel you to disclose what appears to you to be irrelevant information. You must not disclose personal information to a third party such as a solicitor, police officer or officer of a court without the patient’s express consent, unless it is required by law or can be justified in the public interest.
Personal information may 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. You must weigh the harms that are likely to arise from non-disclosure of information against the possible harm, both to the patient and to the overall trust between doctors and patients, arising from the release of that information.
The GMC advises that factors that may weigh in a decision to disclose in the public interest include the nature of the information to be disclosed, what use will be made of it, by how many people, with what safeguards and with what potential for distress or harm to patients. Need for disclosure in the over-riding interests of public safety is a particular concern that may arise. Occupational physicians should seek the advice of colleagues or a professional body if faced with such a serious dilemma.