Intended for healthcare professionals

Practice Competent Novice


BMJ 2008; 336 doi: (Published 17 April 2008) Cite this as: BMJ 2008;336:888
  1. Julius Bourke, specialist registrar, ST4 1,
  2. Simon Wessely, head2
  1. 1General Adult Psychiatry, Maudsley Hospital, London SE5 8AZ
  2. 2Department of Psychological Medicine, Institute of Psychiatry, King’s College, London SE5 8AF
  1. Correspondence to: J Bourke Julius.bourke{at}

Confidentiality in the medical setting refers to “the principle of keeping secure and secret from others, information given by or about an individual in the course of a professional relationship,”1 and it is the right of every patient, even after death.2

Breaches of confidentiality are common, albeit usually accidental.2 Around a third of the calls received by the Medical Protection Society from doctors are related to confidentiality, particularly in general practice.3 It is the most common reason for doctors, at any stage of their training, to seek advice from their indemnity unions. Confidentiality lies at the heart of the relationship between doctor and patient, and one survey suggests that the public view any breaches of this as the most important reason for striking doctors off the medical register.4

Maintaining confidentiality is part of the “good faith” that exists between doctor and patient.5 Ignoring patients’ rights to confidentiality would lose their trust, and might prevent people from seeking help when needed. Confidentiality preserves individual dignity, prevents information misuse, and protects autonomous decision making by the patient.6

Key points

  • Take care with personal data: do not disclose details in a public place and do not allow letters, notes, or electronic data to be accessed by others unnecessarily

  • Ask yourself whether disclosure is really necessary

  • Always try to obtain consent to share patient data and if not possible discuss with a senior colleague

  • Contact your indemnity union for advice in tricky situations

  • Keep notes as this shows that you have thought about the problem and provides documentary evidence

  • If contacting a patient by phone, use their personal number and make sure you are talking to the patient

  • Any patient objections to clinical audit must be taken into account; express consent is needed when audits are carried out externally …

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