The Pharmaceutical Journal
Vol 279 No 7477 p533-536
10 November 2007

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When confidences should be kept and what constitutes an exception

In the final article of a series on the 2007 code of ethics, Joy Wingfield discusses the issues around confidentiality and privacy, and how they affect professional boundaries

Continuing professional development articles

Code of ethics series

SUMMARY

In some ways, confidentiality and privacy are matters of taste. Most of us would recoil from the idea of a closed-circuit television surveillance camera, monitored by the authorities, in our living room, as envisaged in George Orwell’s novel ‘1984’, yet the participants in television’s “Big Brother” do not seem to mind.

Similarly, some patients are prepared to whip off clothing on the shop floor to show you their rash, whereas others will not voice their concerns unless assured of absolute secrecy.

The presumption, however, is that health care related information should be regarded as confidential unless other overriding considerations apply. If this was not the case, patients would not confide in us and would not have confidence in our discretion.

Taken to its extreme, if confidentiality of health care information were not the norm, the effectiveness of health care would be undermined — the general public could be at risk if patients could not trust that their confidences would be respected and they, therefore, went untreated.

As with consent (see PJ, 13 October, pp411–4), keeping confidences is a part of showing respect for patients and under principle 3 of the 2007 code, two statements are made:

• “Respect and protect the dignity and privacy of others. Take all reasonable steps to prevent accidental disclosure or unauthorised access to confidential information and ensure that you do not disclose confidential information without consent, apart from where permitted to do so by the law or in exceptional circumstances.” (statement 3.5)

• “Use information obtained in the course of professional practice only for the purposes given or where otherwise lawful.” (statement 3.7)

However, in principle 4 of the code, there appears the statement:“Subject to paragraph 3.5, ensure that information is shared appropriately with other health and social care professionals involved in the care of the patient.”

So the duty to keep patient matters confidential is relative. There may be circumstances in which a pharmacist must disclose such material or when he or she may disclose, subject to his or her judgement and discretion.

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