Confidentiality and Information Sharing

Confidentiality is a cornerstone of the doctor-patient relationship. Patients share deeply personal information — medical history, mental health, lifestyle, relationships — on the understanding that it will be kept private. Breaching confidentiality without justification is both unethical and illegal. However, there are important exceptions where confidentiality can and must be broken.

SJT scenarios frequently test your understanding of when to maintain confidentiality, when to break it, and how to share information appropriately.

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The General Rule: Confidentiality Is the Default

Unless there is a specific reason to share information, keep it confidential. This applies to:

Information type	Examples
Medical information	Diagnoses, test results, treatment plans, medications
Personal information	Address, phone number, employment, relationships
Information shared in consultation	Anything a patient tells their doctor
Information from medical records	Notes, letters, referrals, imaging
Information about attendance	Whether someone has visited a clinic or hospital

The Practical Meaning of Confidentiality

You should	You should not
Discuss patients only with those directly involved in their care	Discuss patients in public areas (corridors, lifts, canteens)
Use the minimum information necessary	Share more detail than needed "for context"
Ensure conversations cannot be overheard	Have clinical discussions near patients, visitors, or the public
Keep written records secure	Leave notes visible on a desk or screen
Log out of computer systems when finished	Leave patient records open and unattended
Dispose of patient information securely	Put patient documents in regular bins

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When Confidentiality Can Be Broken

There are specific, limited circumstances where it is lawful and ethical to share patient information without their consent.

1. With the Patient's Consent

The simplest exception: if the patient gives explicit consent for their information to be shared, you can share it.

Example: A patient asks you to send a letter to their employer explaining their absence. With their written consent, you can do so.

2. Within the Healthcare Team (Need-to-Know Basis)

Information can be shared with other healthcare professionals directly involved in the patient's care. This is implied consent — patients understand that the team treating them will share relevant information.

Crucially: This is on a need-to-know basis. A porter does not need to know a patient's diagnosis. A pharmacist needs to know about allergies but not about the patient's family history of mental illness.

3. Risk to the Patient or Others

Confidentiality can be broken when there is a serious risk of harm to the patient or to other people.

Scenario	Justification
A patient with epilepsy who continues to drive against medical advice	Risk to the public — you can inform the DVLA
A patient discloses they intend to harm someone	Risk to others — you can inform the police
A child protection concern	Safeguarding duty — you must report to social services
A patient with a notifiable disease (e.g., certain infectious diseases)	Legal requirement — you must inform public health authorities

4. Legal Requirement

Certain laws require disclosure:

Law/Requirement	What it mandates
Court order	A court can order disclosure of medical records
Notifiable diseases	Certain infectious diseases must be reported
Terrorism	Obligation to report suspected terrorism financing or preparation
Road traffic accidents	Police can request information about drivers involved in accidents

5. Public Interest

Even without a legal requirement, information can be disclosed in the public interest — when the benefit to the public outweighs the patient's right to confidentiality.

The public interest test:

• Is there a serious risk of harm to others?
• Is disclosure proportionate to the risk?
• Have you considered all other options (e.g., encouraging the patient to disclose voluntarily)?
• Is disclosure to the right person/authority (not to the media or general public)?

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Sharing Information with the Healthcare Team

The Need-to-Know Principle

Share with	What to share
The doctor taking over care	All clinically relevant information
The nurse administering medication	The medication, dose, route, allergies, and relevant history
The pharmacist	Medications, allergies, and relevant medical history
The physiotherapist	The condition, mobility status, and relevant precautions
A colleague not involved in care	Nothing — unless the patient consents or there is a specific reason

Handover

When handing over a patient's care (e.g., at the end of a shift), you should share all information necessary for safe ongoing care. Insufficient handover is a patient safety issue.

SJT application: Failing to hand over important information is usually rated as "very inappropriate" because it directly risks patient safety.

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Confidentiality Scenarios in SJT