The Pharmaceutical Journal
Vol 279 No 7479 p589
24 November 2007

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Letters to the Editor

Ethics

How can confidentiality and patient care be reconciled?

From Mr S. D. Morgan, MRPharmS

I read the article by Joy Wingfield on confidences (PJ, 10 November 2007, p533) with interest.

The “real life situations” contained an example where a young man who was collecting a prescription on behalf of his grandmother asks: “Can you tell me which one is for what, because she gets rather confused these days?” The suggested response (PDF 20K) states that as you cannot presume consent to disclosure you should “politely refuse” (Code of Ethics — standards of confidentiality).

This type of situation is a common, indeed a typical scenario. Just as many prescriptions are collected by relatives or representatives as by patients themselves. Obtaining explicit consent from a non-present patient is often not possible. In the example given, one would presume at least that the patient has consented to the grandson collecting her prescription, but even this cannot be proved.

Elsewhere in the Code of Ethics we are reminded that we must “make the care of patients your first concern” and “encourage the effective use of medicines and be satisfied that patients, or those who care for them, know how to use their medicines”. Where a new medicine is prescribed, a dose of an repeat medicine is changed, or where there is potential confusion I would consider that it is therefore my first concern to explain the proper use of the medicine.

Giving out medicines to representatives in a sealed bag does not assure confidentiality. If we are sufficiently satisfied to dispense the medicine to the grandson, then we should be satisfied to give supporting advice.

We could protect ourselves and refuse to issue the prescription as well as refusing to disclose any information to representatives, or we could apply discretion and common sense in determining the relative risks.

Confidentiality is important but so is patient care. How do we reconcile the two concerns in these common circumstances?

Simon Morgan
St David’s, Dyfed

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