Introduction

Information about a patient that a doctor acquires during a professional relationship with the patient is confidential. It may not normally be revealed to others except with the consent of the patient concerned. But does this position admit of exceptions? We argue it does and describe those exceptions here.

Confidentiality

Although the publication of information that enables the patient to be identified is widely agreed to be a breach of confidentiality, the position of anonymised information is more contentious. In one view there is no breach of confidentiality if the patient cannot be identified. Another, stricter, view of confidentiality suggests that revealing anonymised information still amounts to a breach of confidentiality, as it is still revealing details of a private encounter.

Strong reasons exist for preferring the former view. It can be argued that the obligation of confidentiality is restricted to information that is capable of being connected to a particular person. In the absence of such a connection, information simply cannot be confidential. However, any experienced journal editor will recount situations where anonymised information has been recognisable to the patient or family involved and caused upset.

The principle of confidentiality affects the publication in medical journals of any material pertaining to a particular patient or research subject. The policy of the International Committee of Medical Journal Editors on this issue states:

Patients have rights to privacy that should not be infringed without informed consent. Identifying information should not be published in written descriptions, photographs, or pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives written informed consent for publication. Informed consent …