Scenario Type: Confidentiality Dilemmas

Confidentiality dilemmas are among the most nuanced SJT scenarios. They test your ability to navigate the tension between maintaining patient privacy and other competing obligations — including safeguarding, public safety, and the duty of care. This lesson presents the most common confidentiality scenario types with fully analysed worked examples.

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The Core Principle

Default position: Maintain confidentiality. Every departure from this default must be justified by a specific, legitimate reason.

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Scenario A: A Friend Asks About a Patient

The Setup

Someone you know personally (a friend, family member, or fellow student not involved in the patient's care) asks you about a patient. This is one of the most common confidentiality scenarios in SJT.

The Key Principle

You must not share any patient information with anyone who is not directly involved in the patient's care — regardless of:

• How well you know the person asking
• How well they know the patient
• How concerned they seem
• Whether the information seems "harmless"

Worked Scenario

Scenario: Your flatmate, who is also a medical student, asks: "I heard Mrs Taylor was admitted to your ward. Is she OK? She is my neighbour and I am worried about her."

Action	Rating	Why
Explain that you cannot share any information about patients on your ward, even to confirm whether someone is there	Very appropriate	Maintains confidentiality completely; even confirming admission status is a breach
Say "She is fine, do not worry" because it seems like harmless reassurance	Very inappropriate	Any disclosure — even that the patient exists and is "fine" — breaches confidentiality
Suggest your flatmate contact Mrs Taylor directly or through her family	Very appropriate	Redirects the enquiry without breaching confidentiality
Tell your flatmate the diagnosis because they are a fellow medical student	Very inappropriate	Being a medical student does not create a legitimate need-to-know for patients on a different ward

Why Even "Harmless" Information Is Off-Limits

"Harmless" information	Why it is still a breach
"Yes, she is on the ward"	Confirms admission — which they may not have known for certain
"She is doing well"	Implies you have access to her records and know her condition
"I cannot say, but do not worry"	The reassurance itself implies you know something positive
"I have seen her around"	Confirms presence without explicit disclosure, but still breaches the principle

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Scenario B: Social Media Posts

The Setup

You or a colleague posts something on social media that could relate to a patient, a clinical experience, or a placement setting.

The Key Principles

Rule	Explanation
No identifiable information	Do not post anything that could identify a patient — even indirectly
"Jigsaw identification"	A combination of details (ward, condition, approximate age, date) can identify a patient even without a name
No clinical photos	Never photograph clinical settings, patients, or patient-related materials
The persistence problem	Social media posts can be screenshotted, shared, and archived — they are never truly private

Worked Scenario

Scenario: A fellow student posts on a private group chat: "Just had the most amazing learning experience. A young woman came in with a really rare condition I have never seen before — [describes the condition in detail]. Ward 7B, Royal Free Hospital."

Action	Rating	Why
Message the student privately and explain that the post could identify the patient (rare condition + age + ward + hospital = identifiable)	Very appropriate	Addresses the issue directly and educates the student
Report the student to the medical school	Appropriate, but not ideal	A valid step, but a private conversation should come first unless the student has been warned before
Ignore it because the chat is "private"	Very inappropriate	Private group chats can be screenshotted; the breach is real regardless of the platform's privacy settings
Reply in the group chat asking the student to remove the details	Appropriate, but not ideal	Addresses the issue but draws more attention to the details in the group; a private message is better

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Scenario C: Sharing Information with Family Members

The Setup

A patient's family member wants information about the patient's condition, treatment, or prognosis.

The Decision Framework

Step 1: Has the patient given explicit consent for information to be shared with this person?

• Yes → Share relevant information appropriately
• No → Move to Step 2

Step 2: Does the patient have capacity?

• Yes → Ask the patient for consent. If they refuse, respect their decision
• No → Consider whether sharing is in the patient's best interest (see below)

Step 3 (patient lacks capacity): Would sharing information be in the patient's best interest?

• Consider the patient's previously expressed wishes
• Consider who the patient would want to be informed
• Share only the minimum necessary

Worked Scenario