By now, you’ve probably all heard of the term confidentiality and know exactly what it means. In this guide, I will be giving you a deeper look into what is meant by it, and more so in the context of health care providers as well as medical school interviews.
Written by Rozh Akram
What is Medical Confidentiality
By definition, confidentiality means the state of keeping or being kept secret or private. This is closely related to respect for autonomy.
Confidentiality in healthcare relates to the idea of concealing and protecting a patient’s personal and identifiable information from members of the public, and those who are not authorised to have access to such information.
What this means is that medical professionals will only be discussing anything confidential with patients, not their families, friends and spouses. We will only be discussing any relevant information between colleagues on a need-to-know basis. Essentially, we do everything we can to protect our patients confidently, no matter how small or big it is.
Patients are also allowed to see their own records and under the Data Protection Act (1998) – this data must be accurate, held for defined purposes, relevant and neither kept any longer than necessary nor disclosed to unauthorised persons.
What Does Medical Confidentiality Cover?
Medical confidentiality can extend to almost anything a patient shares with a doctor. This will range from medical conditions to actions you have taken and personal information you have shared. While the majority of patients will be entitled to full confidentiality, are there cases where this can be broken?
Can Confidentiality Be Broken?
Of course, confidentiality could be broken at any time, but this would be in direct violation of the rules medical practitioners follow. In terms of breaking confidentiality in a legal and ethical manner, there are various examples where it would be allowed.
Firstly, confidentiality is not breached if the patient gives consent for his/her information to be shared or if it is shared with others involved in the patient’s care.
Primarily, confidentiality can be broken in the event that the patient poses any immediate danger to either themselves or anyone else. For example, if a patient claims that they will cause harm to members of the public (or themselves), then you have a duty to break their confidentiality and notify the correct authorities.
In regard to other criminal activities that you have been made aware of, the rules are somewhat inconsistent. In cases of non-violent crimes, it usually comes down to your judgement, though you must always be aware of the risk of reporting.
The same is true if the authorities contact you for information, though they usually only do so if the breaking of confidentiality without consent is justified. For example, all citizens (including doctors) are required to disclose any information that may prevent an act of terrorism (under section 38B of the Terrorism Act 2000).
In one famous case (1-), a doctor broke confidence and sought permission to disclose the medical records of patient W, an extremely violent serial killer, to the Home Office and the medical director of the hospital caring for W so as to inform them of how potentially dangerous he could be.
Another example of when confidentiality can be broken is in the event when a patient tests positive for a transmittable disease such as HIV, and they are having regular intercourse with a partner.
In circumstances like this, we would advise the patient to tell their partner directly and give them a timeframe to do so. However, if they have not done that yet, then you will have a duty to notify their partner about the situation and you will need to tell the patient that you will be doing so.
Please note that HIV is not a notifiable disease and you will not need to notify the authorities but rather anyone the patient might be sleeping with if they choose not to disclose their HIV-positive status to their partner(s). However, there is a list of notifiable diseases that you will need to disclose to the authorities under the Health Protection (Notification) Regulations 2010:
Notifiable Diseases In The UK
- Acute Encephalitis
- Acute Meningitis
- Anthrax
- Brucellosis
- COVID-19
- Enteric Fever (typhoid or paratyphoid fever)
- Haemolytic Uraemic Syndrome (HUS)
- Invasive Group A Streptococcal Disease
- Leprosy
- Measles
- Mpox
- Plague
- Rubella
- Scarlet Fever
- Tetanus
- Typhus
- Whooping Cough
- Acute Infectious Hepatitis
- Acute Poliomyelitis
- Botulism
- Cholera
- Diphtheria
- Food Poisoning
- Infectious Bloody Diarrhoea
- Legionnaires’ Disease
- Malaria
- Meningococcal Septicaemia
- Mumps
- Rabies
- Severe Acute Respiratory Syndrome (SARS)
- Smallpox
- Tuberculosis
- Viral Haemorrhagic Fever (VHF)
- Yellow Fever
- Acute Encephalitis
- Acute Infectious Hepatitis
- Acute Meningitis
- Acute Poliomyelitis
- Anthrax
- Botulism
- Brucellosis
- Cholera
- COVID-19
- Diphtheria
- Enteric Fever (typhoid or paratyphoid fever)
- Food Poisoning
- Haemolytic Uraemic Syndrome (HUS)
- Infectious Bloody Diarrhoea
- Invasive Group A Streptococcal Disease
- Legionnaires’ Disease
- Leprosy
- Malaria
- Measles
- Meningococcal Septicaemia
- Mpox
- Mumps
- Plague
- Rabies
- Rubella
- Severe Acute Respiratory Syndrome (SARS)
- Scarlet Fever
- Smallpox
- Tetanus
- Tuberculosis
- Typhus
- Viral Haemorrhagic Fever (VHF)
- Whooping Cough
- Yellow Fever
Again, you will need to inform your patient that, because of the nature of the disease they have, you will need to identify the authorities in order to protect the health and well-being of others.
Additional examples where confidentiality could be broken include:
- When required by a judge in court or if issued a warrant under the Police and Criminal Evidence Act (1984).
- To a coroner if they request information about a deceased person whose death they are investigating.
- To provide evidence about a living person during a public inquest 88.
- To police under the Road Traffic Act (1983) but in this case they are only required to provide the name and address of the person.
- Under suspicion of child abuse of any kind.
- The registration of births and deaths.
- Children born under the Human Fertilisation and Embryology Act (1990).
- Perhaps most controversially, under the Abortion Act (1967), the Chief Medical Officer must be notified of all terminations of pregnancy.
Why is Confidentiality Important?
Confidentiality in medicine is important for a number of reasons:
Public Trust in the Profession
The public needs to be assured that their personal information is safe, especially in sensitive situations. It also demonstrates competency when information is kept safe.
Vulnerability and Stigma
Patients are often required to share very personal details that they wouldn’t want to be known by either people they know or complete strangers.
Data Safety & Identity Theft
Patients will often need to provide contact information, addresses and other information that could be exploited by third parties.
Privacy
All patients are entitled to privacy when they do not pose a risk to themselves or others. In most cases, this is considered a basic human right.
The risk of confidentiality breaches has increased significantly with electronic storage of information, and it’s pretty easy to see that while a patient is in hospital, their confidentiality is hardly kept under lock and key with their medical chart hanging at the end of their bed for anybody to pick up and look at.
Therefore, the topic is quite commonly brought up during medical school interviews.
Confidentiality Questions In medical School Interviews
Here are some examples of medical school interview questions about confidentiality:
1️⃣ Why is data confidentiality important?
2️⃣ Tell me how patient confidentiality is handled in a healthcare setting?
3️⃣ Scenario: a patient has tested positive for HIV and claims they are sexually active. What would you advise? They come back a few weeks later and state that they still have not told their partner, what would you do?
4️⃣ You are a medical student on a public bus home from your clinical placement. You notice that two of your placement partners are also on the same bus as you, but they do not know that you are also on the bus. You can clearly hear them discussing their interactions with the patients today and identifiable information about the patients. You can clearly tell which patients they are referring to. What would you do?
Let’s take a look at Question 4️⃣ and see how you could answer this in an interview:
In a scenario like this, it’s important to recognise the importance of patient confidentiality, even more so in this case because sensitive information is being discussed in a public place. It is important to protect patient confidentiality in this scenario because of the following reasons:
1. This will feel incredibly uncomfortable and demoralising if the patient or any family/friends of the patient are on that same bus and recognise that they know who is being spoken about. More so if the patient has any condition that their friends and family do not know about and even worse if it’s something that can be stigmatised like HIV.
2. The public’s perception of doctors and the medical profession as a whole will be compromised, as they will develop the mentality that their details will also be spoken about publicly like this.
I would deal with this situation by directly going up to my colleagues and reminding them of the importance of protecting patients’ confidentiality and not discussing any identifiable information in a public setting.
I would kindly advise them to stop talking about anything that could potentially result in compromising the patient’s identity, even if it’s just their physical appearance because of what I mentioned in my first point. I will ensure that I do this in a non-confrontational manner so I do not come across as patronising in any way.
One could argue that this should be reported to my superiors straight away but in this scenario, I have chosen to give them the benefit of the doubt as they are still just medicine students and may not be fully aware of the rules yet. Should they continue their conversation or if I notice this behaviour again, I would need to report these incidents.
This may not be the right response for all scenarios, and you may have a different option about how the matter should be handled, That’s okay, and you should always answer with what you believe in an ethical scenario.
This model answer simply demonstrates the thought process and verbal explanation one should take when given an ethical scenario to react to in an interview.
This concludes our guide to medical confidentiality, I hope it’s been useful for you. There are many more ethical matters that may come up in your interviews, so be sure to check out the rest of our Medical Ethics Guides.
If you’re interested in working with expert medicine tutors for one-to-one sessions and mock interviews, be sure to explore our Interview Tutoring Bundles and Medicine Mastery Bundles to boost your performance in your med school application. Good luck!
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