Capacity to manage care - part two

Background

Dr Praed is the doctor to James Green who is 22 years old. James has a moderate learning disability and type 1 diabetes. 

Until a month ago he lived with his mother, Linda Green, and relied on her for practical support such as monitoring his diabetic control and reminding him to attend appointments.  After a series of arguments with his mother, James moved out into shared accommodation with new friends.  His mother, Linda, has told Dr Praed that James has been regularly binge-drinking and that she doubts he has been taking his medication.

Dr Praed talked to James. He explained to James that he would benefit from some help and that he intends to call the local adult safeguarding team to ask them to provide some support to him.  James became very angry at what he sees as Dr Praed’s interference and left the consultation.

Scenario

After James leaves, Dr Praed telephones the local adult social services to raise his concerns. He explains that he has concerns about James's ability to understand and manage his health and also that he may be at risk from others. The social worker says this is an urgent referral and that the team will contact James within 24 hours.

Dr Praed is contacted by the police the next day. The social worker had found James unconscious, apparently following an assault. The police tell Dr Praed that several witnesses have identified James’s friend, Paul, as the main suspect for the assault. The police ask if Dr Praed knows what James's relationship is with Paul and whether he knows anything else about him.

Although James is expected to regain consciousness soon, the police are very keen to get further information quickly. Officers ask Dr Praed to hand over James's records.

What the doctor did

Dr Praed considers that, as a serious assault has been committed, disclosure of relevant information about James is likely to be justified in the public interest. 

Dr Praed considers whether he should disclose relevant information without delay in the public interest, or wait until he can ask James. He decides that he would tell the police what he knows about James's relationship with Paul even if James refused consent, and that further delay in the police investigation might leave others at risk of harm. He resolves to tell James what he's done after he regains consciousness.  

Dr Praed also considers whether it is safe and practicable to seek Paul's consent to disclose information about him, or if that would undermine the purpose. In discussion with the police, he is convinced that there is a significant risk of Paul absconding if he learns that the police are looking for him. He therefore decides to disclose what James has told him about his relationship with Paul, the address at which Paul is registered and the pharmacy at which he obtains repeat prescriptions. It is clear that the police already know about Paul's drug addiction.

What the doctor had to consider 

• Doctors should seek consent to disclose information unless it is not practicable or appropriate to do so. For example, this might be because seeking consent would be likely to undermine the purpose of the disclosure, or because action must be taken quickly and there is insufficient time to contact the patient (Confidentiality, paragraph 14).

• Confidential medical care is recognised as being in the public interest as, without it, patients may withhold important information from their doctors, or even choose not to access health services at all (Confidentiality, paragraph 22). But confidentiality is not absolute and disclosures can be justified in the public interest if the benefits to an individual or society of a disclosure outweigh both the patient’s and the public interest in keeping the information confidential. For example there can be a public interest in disclosing information to protect individuals or society from risks of serious harm, such as from serious crime, especially crimes against the person (Confidentiality, paragraph 64).

• It is rarely appropriate to hand over whole records which will inevitably contain irrelevant information (Confidentiality, paragraph 10d and endnote 43).