Doctors asked to play their part in reporting gun and knife crime

New guidance from the General Medical Council (GMC) requires doctors to inform the police or social services whenever they treat a patient who is a victim of gun or knife crime, particularly those under 18.

For the first time, the new guidance is explicit that doctors should report all gunshot wounds and knife crime for both children and adults.  

Knife injuries to children, even accidental ones, may raise wider questions about a child’s safety.  Therefore, doctors need to consider whether there are any concerns that should be dealt with through child protection procedures.

The new guidance, Confidentiality, (which is supported by seven pieces of supplementary guidance including Reporting gunshot and knife wounds) requires doctors to:

• Firstly, inform the police quickly of any incidents of wounds resulting from a gunshot or a suspected attack with a knife, blade or other sharp instrument.
• Secondly, make a professional judgement about whether disclosure of personal information about a patient is justified. For instance, when there is a risk to patients, staff or the public.

The guidance requires doctors to ask patients whether they are prepared to talk to the police, and to explain the potential consequences of not doing so.  However, while doctors must respect a patient’s decision, if it is probable a serious crime has been committed, or staff, or the public are at risk, doctors may now disclose the patient’s identity and other confidential information to the police.

Dr Henrietta Campbell, former CMO in Northern Ireland, who chaired the GMC’s working group on confidentiality, said,

“Confidentiality is central to trust between patients and doctors, but it is still an area of ethics which continues to challenge doctors more than any other.

“We are not asking doctors to force patients to speak to the police, but we are asking them to pass on information which will help the police to help protect patients, the public and staff from risks of serious harm.

“The guidance in Confidentiality applies to all violent crime, but gunshot and knife wounds raise issues that warrant special consideration.  There are occasions when disclosure of certain information may be justified, even if the patient refuses to consent. For example, when failure to disclose information about a patient may put them or others at risk of harm, or when disclosure could help to prevent or prosecute a serious crime.”

Tunji Lasoye, lead consultant, emergency department, Kings College Hospital, who has treated many patients for gunshot wounds and wounds resulting from knife crime, said,

“It is so important for doctors to play their part in the protection of the public and the monitoring of violent crime. One way of doing this is to share appropriate information with agencies in ways that don’t breach patient confidentiality, whenever possible.  The GMC’s guidance will help doctors to recognise how to report injuries resulting from violence while making the care of their patient their first concern.”

Other areas covered in the guidance also include:

• Reporting concerns about patients to the DVLA, when, due to ill health, a patient might be unfit to drive
• Responding to criticism in the press, which may involve inaccurate or misleading details of doctors’ diagnosis, treatment or behaviour
• Ensuring that school or college students on work experience understand the principles and implications of maintaining patient confidentiality
• Disclosing information for insurance, employment and benefit claims, including advice for occupational health or sports doctors who face ‘dual obligations’
• The use of confidential information for research or health service management, when it isn’t always practicable to use anonymised information or to get patients’ consent.

Confidentiality was produced following a three-month consultation period, in which members of the public, the medical profession, employers and patients were asked for their views on draft guidance.

The guidance can be accessed here:  www.gmc-uk.org/confidentiality

It takes effect on 12 October 2009.