The scene

A GP MDU member saw a male patient who had been struggling with his mood for some weeks, and on two occasions described feeling low and at times irritable at home. The GP agreed to start him on an antidepressant, but the patient was concerned that no one should find out he was unwell.

A few days later the patient's wife left a message asking to speak to the GP about her husband, and the doctor called the MDU's advice line to ask if he could do so.

MDU advice

Speaking to the MDU adviser, the GP explained that he was concerned about possibly breaching the patient's confidentiality if he spoke to the wife.

The adviser explained that it was possible the wife may have information that would be helpful in the member's care of the patient. Although it wasn't a breach of confidentiality to listen to her, the member should make clear at the outset that he might need to tell the patient about information he received from her.

The adviser explained the GMC's expectation that doctors must be considerate and compassionate to those close to patients, but also directed the member to the GMC's confidentiality guidance, which tells doctors to consider whether listening to others may be deemed a breach of trust by the patient. In this situation, the GP member believed that the patient hadn't asked him not to listen to his wife, but didn't want others to know he was ill.

The adviser explained that the member should be careful not to inadvertently disclose information in his call with the wife - for example, by confirming that he was seeing the patient or that he had prescribed medication.

The member also asked where he should document the call with the patient's wife as he was worried the patient might see it. The adviser explained that in paragraph 70 of 'Good medical practice' (2024), the GMC sets out what information should be documented in the clinical records; this includes relevant clinical findings, decisions made and actions agreed, as well as information given to the patient. If the information provided by the patient's wife could influence the care and treatment of the patient in the future, it was clearly relevant for it to be in the record.

Under the Data Protection Act 2018, however, the identity of the wife would be a third party reference, and could be withheld if a disclosure was requested by the patient and she had not provided her consent to its disclosure.

Outcome

The member spoke to the patient's wife and learned that she was particularly concerned about her husband's behaviour. She said that he was drinking heavily at home, to the extent that he was sometimes unable to go to work. She was worried about him driving and also the effect it might have on their children.

She believed her husband would agree to her accompanying him to his next appointment. As such, when they were seen together the GP member was able to address the issues raised in a way that allowed a fuller discussion of the support needed by the patient and his family.

Confidentiality and mental health: speaking to a spouse

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