A GP had been seeing a patient with known mental health issues and a previous history of assaulting a third party. At this consultation, the patient said he had been having a very difficult time with his family recently with arguments and disagreements over access to his young daughter.
The patient then mentioned his intention of going to his ex-partner's house and stabbing her, saying if the doctor told anyone about his plan he would come into the surgery to pay him back for 'grassing'. The doctor had already been in contact with mental health services, who said they would contact the patient, but he wondered whether he should also inform the police. The doctor did not have the ex-partner's contact details.
The adviser explained that the GMC's guidance on Confidentiality (2017) says that while confidentiality is very important for the doctor patient relationship, it is not absolute. Patients may be reluctant to tell a doctor something if they feel that doctor will not keep it confidential, but there are some situations where there can be a public interest in disclosing information to protect individuals from the risk of serious harm or serious crime.
There are some situations where there can be a public interest in disclosing information to protect individuals from the risk of serious harm or serious crime.
The adviser said that that if a doctor thought that failure to disclose would leave individuals exposed to such a serious risk that it outweighed the patient's and society's interest in maintaining confidentiality, the doctor should disclose the information to the police. The adviser said that as the patient had a previous history of violent behaviour and had made a specific threat against his ex-partner, she could therefore be considered at risk of serious harm. Therefore the doctor could disclose the information to the police in the public interest - although the information disclosed should only be the minimum information necessary to allow the police to protect the ex-partner.
The adviser also explained that a doctor would normally be expected to ask for consent to disclose, and to inform patients of the disclosure afterwards. However, in this situation, if the doctor told the patient that he has disclosed the threat to the ex-partner, it might precipitate violence towards him or the staff at the practice, and therefore it would not be safe to do so. The adviser said that the member should document his reasons for the disclosure to the police and why he had not told the patient.
The doctor did disclose information about the patient's threats against his ex-partner to the police and informed mental health services that he had done so. The mental health team and the police went to see the patient and decided that for the protection of others he should be detained in hospital for assessment under section 2 of the Mental Health Act, 1983.
Confidentiality is very important but can be breached in certain situations, and as demonstrated here, one of those situations would be disclosure in the public interest to protect other people. You should normally seek consent to disclose to third parties or tell the patient you are going to disclose, but only if it is safe to do so.
This guidance was correct at publication 16/07/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.