Keeping schtum

Confidentiality is the cornerstone of good practise. All patients expect that personal and clinical information about them will be held in confidence by the dentist and members of the team and will not be released to any third party without their expressed consent. Such information should only be used for the purposes for which it is given.

If standards such as these were not met, clinical relationships would be hard to maintain because:

• Patients might be reluctant to release sensitive information that might be necessary to provide good care and protect themselves and the dentist

• Patients might not seek dental advice when necessary.

All personal information belongs to the patient and he or she has the right to release any such details whenever he or she chooses to do so.

Dentists have an ethical and a legal duty to observe confidentiality. Section three of the General Dental Council’s (GDC) document Standards for Dental Professionals outlines that duty and further information is provided in the council’s guidance document Principles of Patient Confidentiality. Both documents are available on the GDC website

Accidental breach of confidentiality may result in a complaint to the practice, the GDC or, in more serious

circumstances, a civil action for damages. For the practitioner this could result in damage to the practice or personal relationships and potentially adverse publicity. Care in guarding confidentiality is therefore vitally important.

Confidentiality is a team responsibility and must be regularly re-emphasised. Everyone at the practice must guard against improper disclosure of any information such as:

• Deliberate breaches of confidentiality to family or carers

• Inadvertent disclosure to any inappropriate person

• Confidential information is sent to the patient and intercepted by a third party

Furthermore, they must ensure safe storage, retrieval and disposal of any personal or clinical information. Accidental disclosure of personal information is not uncommon. It is the easiest thing in the world for a caring receptionist to congratulate a mother on her daughter’s pregnancy or to commiserate with a daughter about her father’s serious illness. It is vital that no team member communicates any personal information to any third party, however sure they might be that the information is already known.

Care should also be exercised to avoid identifying patients by name on the telephone when other patients in the waiting area may be able to overhear the conversation. ‘Hello Mrs Jones, thank you for letting me know about the anti-depressant medication’ may sound harmless but may convey much information if Mrs Jones’s neighbour is sitting waiting for an appointment.

As a general principle, no practice team member should speak about a patient in the hearing of anyone else. If an accidental breach of confidentiality occurs the practice should act quickly to minimise any damage as soon as it is discovered. The options are:

1. Offer a full and unqualified apology to the patient

2. Notify the patient of the practice’s complaints procedure if required

3. Undertake a significant review to try to ensure that no similar breach of confidentiality occurs again.

Dentists can share patient information with other practitioners and practice staff on a need-to-know basis. When referring a patient to hospital or to another practitioner for a further opinion, the patient should be informed that personal information about medical history and so on may be included in the referral letter together with the reasons for releasing it and the

consequences of doing so.

The patient has the right to refuse the inclusion of any information in such a letter. The recipient of the information should understand that it is confidential.

In certain circumstances the dentist may decide that disclosure of information is justified without patient

consent. Such a breach of confidentiality should never be undertaken lightly. Such circumstances may arise if:

• There is a legal or statutory requirement

• When ordered to by a court

• In the public interest;

– If the patient puts their health and safety or that of someone else at serious risk

– If you have confidential information which would help detect a serious crime, or where you believe that failure to disclose might allow a criminal to commit a further crime or evade justice

– Where the duty of care to society overrides the duty of confidentiality to the patient.

A dentist may be presented with a court order signed by a judge requiring part or all of the dental record of a patient. In such circumstances the dentist must provide the notes required. If original records are required the dentist should retain a good copy of everything supplied. Police without a court order do not have access to dental records or appointment books.

If the dentist feels that disclosure may be appropriate in the public interest, he or she should weigh the possible harm to the patient and to dentist/patient trust against the possible benefit of releasing such information. On deciding that the information must be released the dentist should do everything possible to persuade the patient to give the dentist permission to do so.

In circumstances where the dentist wants to release information without consent it is wise to obtain advice from the defence insurer wherever possible. If confidential information is released without patient consent the dentist should make detailed notes in case they are subsequently asked to justify any such decision.

Quick Tips

The key considerations of patient confidentiality:

• It should be defended whenever possible

• Only in rare circumstances is breach of confidentiality justified without patient consent

• If a patient’s confidentiality is breached, the dentist should write detailed notes because he or she may be asked to explain and justify the action at a later date

• If in doubt, confidentiality should be preserved and advice sought from the defence insurer.

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