When is it Okay to Breach Patient Confidentiality?

Situations can arise where doctors feel ethically and morally bound to release patient information to protect the welfare of others, as detailed in the case below.

A patient booked a follow-up appointment with Dr Johns, a part-time GP working in a small rural practice. The patient, Peter Jackson, was returning for the results of a CT scan.

When Mr Jackson arrived for the last appointment of the day, he was told that Dr Johns was running behind time. Mr Jackson wasn’t happy about the delay, but said he would rather wait than reschedule as he needed to see the doctor that day.

After ten minutes, Mr Jackson advised the junior receptionist that he had been out of town for a while and wanted to check that his details were up to date. The receptionist, feeling slightly intimidated by the patient, agreed to check his details and opened the patient database. She was surprised when she heard a noise behind her and realised Mr Jackson was now standing directly behind her. The receptionist was alone in the practice except for the doctor. Although she was uncomfortable with Mr Jackson’s request, she was reluctant to ask him to return to the waiting room.

Keen to get the patient away from her desk, the receptionist typed in “Jackson” into the computer. A list of patient names appeared on the screen and the patient pointed to an entry for Peter Jackson, saying, “That’s me”. The receptionist brought up the record – but before she realised it couldn’t be correct because the date of birth only made him 12 years of age, the patient grabbed a post-it note and wrote down the address on the screen.

Mr Jackson smiled at the receptionist and said, “I don’t need that appointment after all – but my ex might need a doctor now that I have her address”.

The receptionist called for Dr Johns who came out of his consulting room immediately. The receptionist was distraught, realising she had inadvertently disclosed the current address of Mr Jackson’s ex-wife and son. Dr Johns had not initially recognised Mr Jackson, but was familiar with the family and aware of a long history of domestic violence which had resulted in the patient being jailed for three years.

Even though Dr Johns had only seen Mr Jackson once, there was still a doctor–patient relationship to consider, so he turned his mind to the issue of privacy and patient confidentiality. He was aware that confidentiality can be breached under certain circumstances, and he formed the view that Mrs Jackson and her son were at serious risk of harm. Dr Johns called both the local police and Mrs Jackson to warn them of the breach and the potential danger to the family, and he provided the police with Mr Jackson’s current address.

Mrs Jackson was picking her son up from after-school sports when she received the call from Dr Johns, and she drove straight to the local police station. Mr Jackson was arrested outside the family home and was returned to jail for breaching his bail conditions.

Mrs Jackson was grateful to Dr Johns for raising the alarm, but was equally concerned about her son’s personal details being released by the practice. The practice responded with an unreserved apology, and Mrs Jackson moved to another town for her own safety.

Nerissa Ferrie
Medico-legal Adviser, MDA National