Doctors advised by MDU on reporting supsected rioters

18 August 2011

The Medical Defence Union (MDU) has advised its members, over half of UK doctors, about when they can report a patient to the authorities in the wake of the riots and looting in English cities this month.

While many of those already arrested have been traced after their CCTV images were published, the search for suspects is likely to continue in the coming weeks and the MDU believes doctors may be approached by the police for information, raising the question of when it is appropriate for doctors to disclose information without patient consent. Alternatively, doctors may believe that a patient has taken part in the disorder, perhaps because he or she has visited the surgery with unexplained injuries such as cuts or even because the patient has confided their involvement during a consultation.

MDU medico-legal adviser, Dr Yvonne McCombie explained: “While doctors' existing duty of patient confidentiality is central to the doctor-patient relationship, doctors can justifiably disclose information about patients if it is in the public interest. However, doctors don't take this step lightly and members often contact us for advice about their ethical obligations in these situations.

“Doctors need to use their judgment to weigh the seriousness of patients' actions against the potential damage to their trust of breaching their confidentiality which may perhaps deter them from consulting a doctor in future. The GMC1 says that information can be disclosed if it is likely to assist in the prevention, detection or prosecution of serious crime. Meanwhile, the NHS Confidentiality Code of Practice2 says that breaching confidentiality can be justified in the case of suspected crimes that threaten serious harm to public order or involve substantial financial gain or loss but may not be warranted in cases of theft, fraud or damage to property where loss or damage is less substantial.

“In this context, if a patient is suspected of offences likely to cause injury, such as throwing missiles, robbery or arson, doctors may feel justified in disclosing information or reporting their suspicions. However, doctors who are in any doubt should first seek specific advice from experienced colleagues or from their defence organisation.”

Here are the key points of the MDU's advice:

Doctors who decide to disclose information to the authorities should do so promptly and this should be the minimum needed for the purpose, such as the patient's name and address, rather their full medical history.

It may not be practicable to seek patient consent or tell the patient if it would undermine the purpose of the disclosure. In this case, doctors should document their reasons for disclosing information without consent and why they have not informed the patient, if that is the case.

There are occasionally situations when doctors are legally obliged to disclose information about a patient, such as in response to a court order. In these circumstances doctors are advised to seek specific medico-legal advice straight away.

Even if the patient is a child, the disclosure of confidential information may be justified in the same way as with an adult if the doctor believes he or she is involved in behaviour that might put them or others at risk of serious harm. Again, this needs to be weighed against the potential damage to the doctor-patient relationship.

Doctors who discover that a young child patient is apparently out alone late at night, may consider whether this indicates they are at risk of neglect or abuse and may want to seek advice from the locally designated person for child protection.

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