Working with doctors Working for patients

 

Introduction

Dr MacDonald is a consultant in emergency medicine at a busy district general hospital. She has been treating a 19 year-old man with a stab wound to the abdomen.

Dr MacDonald is speaking to Craig, the paramedic who brought the patient in. When briefing Dr MacDonald earlier, Craig said the patient had told him that he had accidentally stabbed himself with a knife.

Dr Macdonald

Dr MacDonald

He's still insisting that he stabbed himself accidentally. Where did you say you picked him up?

Craig

Craig

Under the railway arches down by West Hill multi-storey. He was phoned in by an anonymous caller. Nobody else was on the scene when we arrived.

Dr Macdonald

Dr MacDonald

...and you said there'd been some other incidents in that area recently?

Craig

Craig

Three other stabbings in the last fortnight, two of them serious. Seems fairly likely to me that it's gang-related. So I guess you have to tell the police do you? But if the patient doesn't want you to and he says it was an accident...well, patient confidentiality and that...

Dr Macdonald

Dr MacDonald

He's adamant that he doesn't want to involve the police, but I don't see what else I can do. I don't want to scare him away...stop him and others like him from seeking treatment in the future.

What should the doctor do...? (Select A,B or C)

A

Inform the patient she does not believe him and that she has to report her suspicions to the police, then contact the police and give them the patient's details?

B

Inform the police about the knife injury and her suspicion that it may be the result of an attack, but do not give them any information about the patient's identity at this stage?

C

Agree with the patient that she won't inform the police so that he will stay and receive the treatment he needs for his injury?

Dr Macdonald

See what the doctor did

Dr MacDonald calls the police and tells them about the possible stabbing, including where and when it occurred, but explains to them that she can't give them any more details about the patient without his consent at that stage.

References

12. If it is probable that a crime has been committed, the police will ask for more information. If practicable, you should ask for the patient's consent before disclosing personal information unless, for example, doing so:

  • may put you or others at risk of serious harm
  • would be likely to undermine the purpose of the disclosure, by prejudicing the prevention, detection or prosecution of a crime.

13. If the patient refuses consent or cannot give it (eg because they are unconscious), you can still disclose information if it is required by law or if you believe disclosure is justified in the public interest.

14. Disclosures in the public interest may be justified when:

  • failure to disclose information may put someone other than the patient at risk of death or serious harm (you should not usually disclose information against the wishes of an adult patient who has capacity if they are the only person at risk of harm). (See Confidentiality, paragraphs 5759, for further guidance)
  • disclosure is likely to help in the prevention, detection or prosecution of a serious crime.

15. If there is any doubt about whether disclosure without consent is justified, the decision should be made by, or with the agreement of, the consultant in charge or the healthcare organisation's Caldicott or data guardian.

16. You must document in the patient's record your reasons for disclosing information without consent and any steps you have taken to seek their consent or inform them about the disclosure, or your reasons for not doing so.

(Confidentiality: reporting gunshot and knife wounds (2017) paragraphs 12-16)