Practice Set 5: Confidentiality & Data Protection Scenarios

Patient confidentiality is a cornerstone of medical ethics and a legal requirement under the Data Protection Act and the common law duty of confidence. The SJT tests your understanding of when confidentiality must be maintained, when it can legitimately be broken, and how information should be handled in everyday situations.

Confidentiality scenarios in the SJT range from obvious breaches (discussing a patient in a public place) to more nuanced dilemmas (a patient discloses they are a risk to others). The key principle is that patient information should only be shared on a need-to-know basis with those directly involved in the patient's care — unless there is a lawful and ethical justification for wider disclosure.

The Caldicott Principles provide a framework for handling patient-identifiable information in the NHS. They emphasise justifying the purpose of information use, minimising the amount shared, and ensuring access is on a strict need-to-know basis. The seventh Caldicott Principle states that the duty to share information can be as important as the duty to protect it — particularly where sharing is necessary to safeguard a patient or protect the public.

Breaching confidentiality is justified in specific circumstances: when required by law (e.g. notifiable diseases, court orders), when necessary to prevent serious harm to others (e.g. a patient who drives against medical advice with epilepsy), or when the patient gives explicit consent for disclosure.

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Quick-Reference Decision Framework

Situation	Best Response	Why
Colleague discusses a patient in the hospital lift	Politely ask them to stop and explain why	Public spaces are not appropriate for patient information
Patient's family asks for an update without patient consent	Explain that you cannot share without the patient's permission	Confidentiality applies even to family members
Patient discloses they plan to harm someone	Inform a senior and consider disclosure to protect the third party	Serious risk to others can justify a breach
You find patient notes left on a desk in a public area	Secure them immediately and report the incident	Unattended records are a confidentiality risk
A friend asks about a celebrity patient you saw	Refuse to share any information	Celebrity status does not reduce confidentiality rights

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Focus for This Practice Set