Lesson 4.3: Confidentiality
Confidentiality is a legal and ethical duty. It is one of the most tested topics in PLAB 2 ethics stations because the exceptions are nuanced, and the exam deliberately tests the boundaries.
Core Duty and When It Can Be Broken
Information given to you in the course of a professional relationship is confidential. You must not disclose it without the patient's consent unless a specific exception applies.
| Exception | Trigger | Key Point |
|---|---|---|
| Patient consents | Patient explicitly agrees to the disclosure. | Document the consent clearly. |
| Legal requirement | Notifiable diseases, certain court orders, DVLA notifications. | You must disclose, this is not discretionary. |
| Public interest | Serious, credible risk of harm to an identifiable third party that cannot be prevented any other way. | Weigh carefully. Disclose only the minimum necessary. |
| After death | Coroner (required), clinical audit, assisting bereaved relatives. | Confidentiality continues after death, but not absolutely. |
| Safeguarding | Risk of significant harm to a child or vulnerable adult. | Follow the safeguarding referral pathway. |
Public Interest Disclosure — The Test
Before breaking confidentiality in the public interest, ask all of the following:
- Is the potential harm serious?
- Is the harm credible, is there genuine reason to believe it will occur?
- Can the risk be reduced another way, for example, by persuading the patient to disclose themselves?
- Will your disclosure actually prevent the harm?
- Are you disclosing only the minimum information necessary?
Always tell the patient what you intend to disclose and why, before you do it, unless doing so would increase the risk of harm.
Notifiable Diseases — Must Report Without Patient Consent
Under the Health Protection (Notification) Regulations 2010, these conditions must be reported to the local health protection team:
- Meningococcal disease, measles, mumps, rubella, whooping cough, scarlet fever
- Tuberculosis (TB)
- Cholera, typhoid, food poisoning (Salmonella, E. coli O157)
- Legionnaire's disease
- Ebola, Marburg, and other high-consequence infectious diseases
Inform the patient that you are making the report, unless doing so would undermine public health purposes.
Common PLAB 2 Confidentiality Scenarios
| Scenario | Your Approach |
|---|---|
| Spouse asking about a patient's HIV result | You cannot share without the patient's consent, even for a spouse. Offer to speak with the patient about how to have this conversation and support both parties. If the patient refuses and the partner faces a serious ongoing risk, this may become a public interest disclosure, but only after exhausting every other option. |
| Patient with epilepsy who continues to drive | Strongly advise notification of the DVLA and cessation of driving. Explain the legal, safety, and insurance implications. Document your advice. If the patient refuses and continues to drive, you may notify the DVLA in the public interest, tell the patient this is what you intend to do. |
| Relative requests 'Don't tell my mother her diagnosis' | Your duty is to your patient, not to her son. Acknowledge that he is acting out of love. Explore what he thinks his mother would want. If your patient has capacity and wishes to know her diagnosis, you must not withhold it. |
| Request for information about a deceased patient | Confidentiality continues after death. You may disclose to the coroner (required), for clinical audit, or to assist bereaved relatives in understanding the cause of death. Consider what the patient would have wanted in life. |