Patient confidentiality

Our policy is based on the UK’s Data Protection Act and the English common law of confidentiality. UK authors should be aware that the GMC has extensive guidance on patient consent and confidentiality and that our policy is in line with GMC advice.

1. Any article that contains personal medical information about an identifiable living individual requires the patient’s explicit consent before we can publish it.

We will need the patient to sign our consent form, which requires the patient to have read the article. This form is available in multiple languages.

2. If consent cannot be obtained because the patient cannot be traced then publication will be possible only if the information can be sufficiently anonymised. Anonymisation means that neither the patient nor anyone else could identify the patient.

A consequence of any anonymisation is likely to be the loss of information/evidence.

If this happens we will include the following note at the end of the paper:

Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

Such anonymisation might, at an extreme, involve making the authors of the article anonymous.

3. If the patient is dead the Data Protection Act does not apply, but the authors should seek permission from a relative (as a matter of courtesy and GMC guidance)

If the relatives are not contactable we will balance the worthwhileness of the case, the likelihood of identification, and the likelihood of offence if identified in making a decision on whether we should publish without a relative’s consent.

4. Special cases: Children. Parents or guardians can consent on their behalf but for older children who are competent to make a decision we expect authors also to seek the child’s consent. For younger children, even if parents consent, authors should consider whether the child, when older, might regret publication of his or her identifiable details.

5. Special cases: Patients who lack capacity. If the patient lacks the mental capacity to make a decision about publication then our advice is that usually no one can give consent on behalf of the patient. Even if someone has this power, by means, for example of a health and welfare Power of Attorney, it has to be exercised in the best interests of the patient. There may be some benefit to the patient in having his or her case described in a publication, but usually this is not obvious or certain. In such cases we will normally require any personal information to be anonymised or will not be able to publish it.

6. This policy applies to any identifiable medical information. The most obvious places where this occurs are case reports, anecdotes, and photographs of patients. However, the issue may also arise in articles describing research if the numbers in some subgroups are very small.

Images of patients

5. Our policy on obtaining consent for publication of pictures of patients is a subset of our general policy on patient confidentiality. If there is any chance that a patient may be identified from a photograph or other image or from its legend or accompanying text we need the patient’s written consent to publication in the BMJ.

6. Images – such as x rays, laparoscopic images, ultrasound images, pathology slides, or images of undistinctive parts of the body – may be used without consent so long as they are anonymised by the removal of any identifying marks and are not accompanied by text that could reveal the patient’s identity through clinical or personal detail.

7. An exception to this policy of needing consent for recognisable photographs of individuals is when we use photographs from picture agencies to illustrate news stories and other articles. We state where these photographs have come from and we rely on the fact that the agencies and their photographers have obtained the relevant permissions from the people shown in the photographs. If we doubt that someone photographed could have given consent – owing for example to severe mental illness or learning disability – we will use our discretion and avoid using such images.

Patient consent form

Please use our consent form for any image or description that needs consent to publication. This form is available in multiple languages.

If the patient is a minor but capable of understanding what is being asked please obtain a signed form from both the patient and his or her parent or guardian.

Please print out the form, fill in the details about the article, ask the patient or next of kin to sign the form, and then send or fax it to us or scan it and upload it to our online editorial office as a supplemental file to your article.