Sharing confidential information of cognitively intact older patients: what do patients think? An exploratory study

SIR—Confidentiality is the cornerstone of the doctor–patient relationship. The General Medical Council (GMC) specifically notes that respecting and protecting confidential information are essential duties of a doctor [1]. GMC Guidelines of April 2004 elaborate on this aspect of clinical care: ‘. . . Doctors hold information about patients which is private and sensitive. This information must not be given to others unless the patient consents or you can justify the disclosure . . . Inform patients about the disclosure, or check that they have already received information about it . . .’ [2]. Good communication is another vital element in the delivery of effective care and there is much interplay between these two factors [3]. ‘. . . You must respect patients’ confidentiality. Seeking patients’ consent to disclosure of information is part of good communication between doctors and patients . . .’ [2]. Sharing of patients’ confidential information within the multidisciplinary health care team is commonplace and widely accepted as being in the best interests of patients. GMC guidelines state that patients should be informed of this disclosure and that the disclosure should not occur if the patient maintains objections [3]. Doctors may tend to share patients’ confidential information with groups other than the multidisciplinary team for whom the case that they need to know is less clear (e.g. patients’ relatives). Balancing good communication with these groups against the duty to respect patients’ wishes for confidentiality is common in the care of the elderly. In Scotland, there is a clear legal framework within the ‘Adults with Incapacity (Scotland) Act 2000’ for information to be disclosed to family and carers, etc. for patient benefit [4]. However, this does not apply to older adults who retain capacity. It is part of good practice to ascertain this as it is the duty of the doctor to obtain this information. However, little is known about what information cognitively intact patients in care of the wards for the elderly are happy to have disclosed and to whom. The GMC provides clear standards of care about this issue. We sought to perform an initial audit in our hospital to see how well medical teams were performing compared to these standards. We, therefore, ascertained patients’ views about this issue asking three specific questions: