Case Study Vignettes – Confidentiality and Consent

Nowadays, consent for information sharing is pretty much always sought – except in some circumstances. Patients, clients and even service users are often formally asked to sign consent as to who can receive what information about them before it gets passed around.

It’s the right thing to do.

But this now means that anyone who gives out information on a patient – who hasn’t consented – is actively breaching a confidentiality. Which left me in a bit of a quandary today like this…..

“Jim” has been referred to the community mental health team. The GP sends his usual style referral letter:

Thank you for agreeing to see this 24 year old man who came to see me today complaining of feeling low in mood. Jim reports a history of being sexually abused as a child by his paternal uncle. His father left the family home when Jim was about 5 and his mother passed away when he was 12. Since then Jim has remained living with his maternal grandmother.

Jim denies any thoughts of homicide but says he has been thinking of suicide but does not want to carry it out and has no plan. He denies any auditory or visual hallucinations though states he can frequently become paranoid. He is a heavy user of cannabis and infrequently binge drinks. Eating and sleeping have been poor and inconsistent.

He was not on any medication at the time he saw me but I have commenced him on Effexor 75mg as of today.

Jim is aware of, and consents to, my referring him to you.

[Actually, that's a pretty good letter for a GP. Pity it's fictional. Anyhooos... ]

The standard community protocol is to complete an assessment and review with the Consultant Psychiatrist at the weekly clinical meetings. You try to contact Jim for his first interview but no answer.

Two days later you get a call from Dr Crippen -

“Did you manage to catch up with John I referred to you?”

“No, sorry. He hasn’t been answering his phone.”

“Well he won’t be likely to now as his grandmother informs me he was taken into custody over the weekend for getting drunk and smashing some windows down town. I am concerned he might have become more paranoid and might even become more suicidal. I was hoping you’d be able check and see that he gets followed up in the prison? I told his grandmother we’d do what we can and let her know”

……

Now bearing in mind that Jim has consented to the GP informing you of his ailments – you have yet to see him to obtain that same consent – or to share the information you have with anyone.

The GP clearly has no desire to be chasing down Prison Mental Health Staff – after all, YOU are mental health staff so you’d know the system better – right?

Doc Crippen is still on the line – What to do?