1. A 15-year-old has injured his shoulder lifting weights in the gym. His father has brought him into the emergency department. While his father steps out to take a phone call, you continue to assess the boy, who you believe is Gillick competent. When you ask if he is on any other medication, he confides he is taking human growth hormone and anabolic steroids to build up muscle. He asks you not to tell his father. What do you do?
A - You believe the patient is acting against his own best interests by taking the drugs. You have a quiet word with his father in the waiting area.
B - Explain to the patient the risks he is running and encourage him to talk to his parents. You also give him the number of a drugs support group for further advice.
2. You and the other students from your year at medical school have set up a Facebook group. You use it to:
A - Tell them about the amusing patients and interesting conditions you see while on your placements. After all, this is a closed group so no one else can read what you write.
B - Arrange nights out with your friends and keep in touch.
3. A journalist calls the GP surgery where you are on a rotation. A patient has alleged that you failed to examine her broken wrist, leaving her in pain for three days. The journalist wants your side of the story. Do you:
A - Tell him that a scaphoid fracture is always difficult to diagnose, particularly when the patient fidgets and won't allow you to examine them properly.
B - Explain you cannot comment because of your duty of patient confidentiality and call the MDU straight away.
4. During a ward round you see a patient with painful keloid scarring following breast reconstruction surgery. You have a particular interest in dermatology and with her consent you take a picture on your phone. A friend who is also interested in the specialty later asks you to forward the image. What do you do?
A - Send the image, along with a few relevant details about the patient's age and treatment.
B - Explain that you cannot do this without the patient's informed consent.
5. As you are passing through reception you overhear a receptionist joking with a colleague about an obese patient who has broken a chair in the consulting room, within earshot of other patients. Do you:
A - Join in with a joke of your own about fat patients. After all, a sense of humour is important in medicine.
B - Tell your supervisor what you have seen. He later arranges for all reception staff to attend refresher training on patient confidentiality.
6. You observed an emergency caesarean section while on placement in obs and gynae. A couple of weeks later, you are in the supermarket when you see the patient shopping with a friend. Do you:
A - Introduce yourself to the patient, congratulate her and wish her a speedy recovery. You later remember she was desperately disappointed that she hadn't given birth 'naturally'.
B - Leave her alone. You don't want to risk embarrassing her and breaching her confidentiality by discussing her treatment in public.
7. You have treated a patient who sustained minor facial injuries. Shortly after he is discharged, you are approached by a policewoman wanting to know his name and address as he is suspected of leaving the scene of a robbery. What do you do?
A - Pass on the patient's details straight away, believing you must assist the police.
B - You don't believe you would be justified in disclosing this information in the public interest in these circumstances and explain that you need the patient's consent to pass on his details.
How did you do?
You may be too easily tempted to reveal confidential information about a patient and the care they are receiving when this cannot be justified. Even if you are acting with the best of intentions, disclosing such details without the patient's consent can easily result in a complaint and get you into difficulties with your medical school, deanery or even with the GMC.
Congratulations. You clearly understand your central role in safeguarding patient confidentiality and are unlikely to undermine the trust patients will place in you.
The MDU's medical ethics and law online learning module (themdu.com/learn) contains a wealth of information about the principles of confidentiality and how this important principle relates to everyday practice.