Medical life: Patients' trust must not be betrayed in the wake of the riots
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Tuesday 23 August 2011
In 1981, after the Brixton riots, violence broke out in other parts of London, including Hackney, where I lived. Battles between rioters and police led to injuries and, after one of these incidents, my GP at the time – Robert Lyle – happened by Hackney Hospital Accident and Emergency. There he witnessed a woman police constable going through the A&E register with a nurse. "And this was a head injury, was it?" the Pc was saying, as she noted down the patient's name and address.
Dr Lyle was outraged at this blatant breach of patient confidentiality. It was obvious the police were using A&E records to identify rioters, whom they could then arrest. Twenty four hours later he vented his anger on the BBC Today programme, where he observed that if injured rioters feared being shopped to the police they would not seek treatment at A&E.
His intervention triggered a national debate about the duties of doctors to patients in circumstances where a crime might have been committed.
In the decades since, the General Medical Council has refined its advice, making it clear that doctors' overriding duty is to protect patients' confidentiality and only in cases of the most serious crimes are they entitled to breach it.
Thirty years on, following the 2011 riots, the Medical Defence Union, which provides legal support to doctors, last week issued its own advice about shopping rioters to the police. Unfortunately this document gets the balance so completely wrong that it represents a disgraceful betrayal of patients' trust.
The tenor of the advice is established with its opening sentence – "The MDU has advised its members about when they can report a patient to the authorities" – and continues: "While doctors' duty of confidentiality is central to the doctor-patient relationship, doctors can justifiably disclose information about patients if it is in the public interest."
It does say information may only be disclosed in the case of "serious" crime which "threatens serious harm to public order or involves substantial financial gain or loss", but fails to stress it. Knocking off a pair of box-fresh trainers or a nice new laptop doesn't count – the kind of crimes of which the vast majority of those convicted in the recent riots have been guilty.
It is the spirit of the MDU advice that is wrong – not its letter. It utterly fails to emphasise the absolute priority doctors must accord to patient confidentially if they are to maintain their patients' trust. The document should have opened by saying doctors must only dare to breach it in the most extreme circumstances and when they do so, they must be prepared to defend themselves in front of the GMC.
It is not the medical profession's responsibility to maintain law and order – its duty is to provide care to those who need it, non-judgmentally, without fear or favour. If doctors lose sight of that, we are doomed.
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