WHO ARE WE KIDDING ON CONFIDENTIALITY?

And then as doctors we need to tell others about our patients. We need to write up to surgeons to get the patient’s hernia repaired. We need to write to the physiotherapist about someone’s bad back. We need to reply to the people listed above who all want to know about our patients. With so many people interested in what is happening in medicine what chance have I as a GP got of keeping confidentiality?

Fundamentally medicine has moved far beyond the one doctor-one patient scenario of Hippocratic days and with this confidentiality has become an ever more strained concept. Indeed I now think it is largely a mockery of the idea of confidentiality to describe my work as confidential.

However the more stretched a concept becomes the more tenaciously people cling to its wreckage. For example an insurance company writes to me about a patient and assures me that my replies will be treated “in strictest confidence.” But if the information was really held in strictest confidence I would not even admit whether I had it or not, still less tell it to anyone.

How can the GMC1 provide guidance on confidentiality that has as its subtitle, “Protecting and providing information.”? Confidentiality does not admit of “providing information” at all. It is notable that in the glossary the relevant terms are defined, except for confidentiality itself. A glance at the dictionary shows why they omitted this.

We need a new concept to replace confidentiality. It is not even an entirely good concept. There are evil people who have confessed all to their priests but who have not apologised or made reparation of any sort to their victims. Should we really praise the priest’s confidentiality when we know that others could benefit from knowing what they know or that harm could be prevented if the priest broke confidentiality?

How private an event is life anyway? The Gospels predict that “all that is hidden will be revealed” John Donne points out that “no man is an island.” We need to drop our pretence of confidentiality. Medicine is no longer confidential. Indeed to function well it has to connect with a wide network of others, and the consequence of this is that it cannot remain confidential. We need to let patients know that we will respect their data, but that we cannot keep it secret, and that outside bodies will be interested in it at some stage of the patient’s life. We need to let patients know which outside bodies are interested and why.

We need also to acknowledge that these outside bodies have a legitimate interest in our patient’s lives. The insurance companies will charge more to higher risk customers. The benefits agency does not want to pay out for plumbum oscillans. I do not want to pay higher tax or insurance premiums to subsidise such cases.

Medicine sits at the hub of an information network and as doctors we are now as much information handlers as practitioners and we need to be conscious and careful about what bits of information we send out along which spoke. But can we please stop pretending that we are “confidential”?

Other hoolet online articles by Peter Davies can be found at:
hoolet edition 48 - Three Theories
hoolet edition 46 - Whinging
hoolet edition 44 - Cons In The Consulting Room
hoolet edition 41 - Who are we kidding on confidentiality?
hoolet edition 40 - First, let's kill the bureaucrats
hoolet edition 38 - Waking up from the medical matrix: Reality and its representation in medicine
hoolet edition 36 - Festina lente
hoolet edition 35 - Determinants or Prerequisites?
hoolet edition 34 - Propulsion Systems in Medicine
hoolet edition 32 - Time to give MRCGP away?
hoolet edition 31 - Proper work for a doctor
hoolet edition 30 - The Intruder
hoolet edition 29 - Edging towards the truth: Does it make any sense at all?
hoolet edition 28 - Thoughts from the Dark Forest
hoolet edition 27 - The Vision Splendid

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.