Worked Examples: A Relative Demands Information About a Patient

Confidentiality scenarios are among the most frequently tested topics in the UCAT SJT. A common format involves a relative — a spouse, parent, adult child, or friend — demanding information about a patient's condition, treatment, or prognosis. These scenarios test your understanding of patient confidentiality, the exceptions to it, and how to communicate sensitively with anxious family members.

---

The Confidentiality Framework

The Core Rule

Patient information is confidential. It should not be shared with anyone — including family members — without the patient's explicit consent, unless a specific legal or ethical exception applies.

Source	What it says
GMC: Confidentiality (2017)	Patients have a right to expect that information about them will be held in confidence by their doctors
Caldicott Principles	Patient-identifiable information should only be shared when absolutely necessary and on a need-to-know basis
Data Protection Act 2018 / UK GDPR	Health data is "special category" data and subject to strict processing conditions
NHS Constitution	Patients have the right to privacy and confidentiality
Common law duty of confidence	Established through case law — a duty of confidence arises whenever information is shared in circumstances of confidence

Exceptions to Confidentiality

Exception	Example
Patient consent	The patient has explicitly said "You can tell my wife about my diagnosis"
Statutory requirement	Certain notifiable diseases must be reported to public health authorities
Court order	A judge orders disclosure of medical records
Public interest	The patient poses a serious risk to others (e.g., a bus driver with uncontrolled epilepsy who refuses to stop driving)
Best interests (incapacitated patient)	A patient lacks capacity and sharing information with family members is in the patient's best interests
Safeguarding	Concerns about child abuse or vulnerable adult abuse

What "Consent" Means in This Context

Consent to share information must be:

• Explicit — the patient has actually said or indicated that you can share information
• Specific — consent to share with one person does not automatically extend to others
• Current — consent given previously may not apply to new information
• Voluntary — the patient has not been pressured into agreeing

---

Worked Example 1: A Spouse Phones for Results

Scenario: You are a medical student working in a GP surgery. The phone rings and a man identifies himself as Mr Khan. He says, "My wife had blood tests last week. Can you tell me the results? She asked me to call because she's at work."

Rate the appropriateness of each response:

Response A: "I'm sorry, but I'm unable to give out patient information over the phone to a third party. I'd recommend your wife calls us directly, or she can nominate you in person to receive information on her behalf."

Rating: Very appropriate

Analysis:

• Politely declines to breach confidentiality
• Explains why (third party, phone — cannot verify identity or consent)
• Offers a constructive alternative
• Does not make the caller feel like they are being accused of anything
• Protects the patient without damaging the relationship

Response B: "Sure, let me pull up her file. What's her date of birth?"

Rating: Very inappropriate

Analysis:

• Breaches patient confidentiality
• You cannot verify the caller's identity or the patient's consent over the phone
• Even if the caller is genuinely the patient's husband, you have no evidence the patient consented to information sharing
• Verifying a date of birth does not constitute verification of consent

Response C: "I can't help you. Goodbye."

Rating: Inappropriate

Analysis:

• While the decision not to share information is correct, the delivery is unnecessarily rude
• Provides no explanation or alternative
• Damages the relationship between the practice and the patient's family
• A professional should be firm but polite

Response D: "I'll check whether your wife has given us permission to share her results with you. Can I take your number and call you back?"

Rating: Appropriate but not ideal

Analysis:

• Recognises the need for consent
• Practical approach — checking the records for a consent note is sensible
• However, calling back a number provided by the caller does not verify that the patient actually wants her results shared
• The best approach is still to have the patient contact the surgery directly

---

Worked Example 2: An Adult Child Demands Information on the Ward

Scenario: You are a medical student on a medical ward. Mrs Green, 78, was admitted yesterday with a chest infection. Her son arrives and approaches you at the nurses' station. He says, "I'm her son. Tell me exactly what's wrong with her and what you're doing about it. I have a right to know."

Rate the appropriateness of each response:

Response A: "I understand you're worried about your mother. Let me take you to see her, and with her permission, I can arrange for the doctor to update you both together."

Rating: Very appropriate

Analysis:

• Acknowledges the son's emotional state (worry)
• Does not refuse to help — instead offers a pathway that involves the patient's consent
• Having the conversation with both the patient and the son present ensures the patient controls what is shared
• Professional and empathetic

Response B: "She's got a chest infection and we're giving her IV antibiotics. She should be home in a few days."

Rating: Inappropriate

Analysis:

• Shares clinical information without confirming the patient's consent
• While the information may seem harmless, the principle applies regardless of how "minor" the information is
• The patient may not want her son to know specific details of her treatment
• Sets a precedent for sharing information without consent

Response C: "I'm sorry, but I cannot discuss your mother's care without her consent. I know that's frustrating, but it's to protect her privacy."

Rating: Appropriate