Confidentiality vignette: reporting the theft of a mobile phone
When can doctors report concerns about patients' criminal behaviour to the police?
Dr O’Hara’s personal mobile phone is stolen from the drug addiction clinic where she works. She has good reason to believe that only six patients had the opportunity to steal the phone, when they attended the clinic for appointments. Nobody else entered her room during the time the phone went missing.
Dr O’Hara contacts her insurance company, who advise her to obtain a crime number from the police in order to claim for a replacement phone. She contacts the police and describes the circumstances in which the phone went missing. The police officer she speaks to asks for the patients’ names, suggesting he needs them if he is to issue a crime number.
Dr O’Hara considers the implications of handing over the patients names to the police. She is aware of the importance of confidentiality to the trust between her and her patients and the fact that even the fact of an appointment could reveal information about her patients that might deter them and others from seeking medical attention in the future. This may be particularly important for patients seeking treatment for drug addiction, who may be especially sensitive to the police being informed (by inference) of their illness.
Dr O’Hara considers the various factors which are relevant to making a decision about what to do. On the one hand, disclosure solely of a patient’s name is not as obvious or usually as serious a breach of confidence as the disclosure of a diagnosis or other detailed clinical information.
On the other hand, she knows that the fact of a patient’s appointment should usually be treated as confidential: the six patients concerned and others might regard even such a limited disclosure as a very significant breach of trust.
After discussing the situation with a senior colleague, Dr O’Hara decides that, although the theft has upset her and cost her financially, disclosing information about her patients is unlikely to be justified, especially given the sensitive nature of their illnesses and as she is unsure which of the patients is responsible for the theft.
Dr O’Hara does, however, report the incident (without the patient’s name) through the clinic’s normal procedures and instigates a review within the clinic about how personal items should be kept and protected to prevent something similar happening in the future.
- There is a clear public interest in a confidential medical service, which is central to trust between doctors and patients (paragraph 6).
- The duty of confidentiality is not absolute, and there can be a public interest in disclosing information without patients’ 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 (paragraph 37).
- Disclosure of personal information may be justified in the public interest without a patient’s consent if it would be likely to assist in the prevention, detection or prosecution of serious crime. However, there is no agreed definition of ‘serious crime’, but it would not usually include theft, fraud and damage to property where loss or damage is less substantial (paragraph 54).
- But doctors are not expected to put up with even petty crime with no recourse to the police, and doctors may be able to justify disclosing information in circumstances like this. Decisions about whether to disclose confidential information (including a patient’s identity, the fact that they had an appointment or the nature of their illness) are often delicately balanced. Doctors need to 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 (paragraph 37).