Some SCA cases involve a relative rather than the patient. These cases are loaded with ethical and legal complexity — particularly confidentiality and consent.
The Legal Framework
Confidentiality (GMC): Patient information must not be shared without explicit consent, unless required by law or in the public interest.
Mental Capacity Act 2005: If the patient lacks capacity, decisions must be made in their best interest considering known wishes, beliefs, and values.
Lasting Power of Attorney: A Health and Welfare LPA grants the attorney healthcare decision-making authority when the patient cannot decide. Verify it exists and is registered.
Fraser Competence: Young people may have confidentiality rights even from parents regarding contraception and sexual health.
| ⚠ COMMON PITFALL: Never assume consent. “I’ll take your word” is a fail-level response. Actively confirm whether the patient has consented to this discussion. |
Step 1: Establish Context
| ✅ ESTABLISHING CONTEXT | Doctor: Thank you for coming in. Could you help me understand your relationship to [patient] and what’s prompted you to speak with me? |
Step 2: Address Confidentiality Early
| ✅ CONFIDENT BOUNDARY | Doctor: I really appreciate you coming in, and I can see you’re worried. I’m bound by confidentiality, so there are limits to what I can share without their permission. However, I’m happy to listen to your concerns and give general information and advice. |
| ❌ BAD EXAMPLE: “I can’t tell you anything. Ask them yourself.” — Technically correct but abrupt and will score poorly. |
Step 3: Listen to the Relative’s Concerns
Even if you cannot share patient information, you can always listen. Collateral history is valuable.
Step 4: Confirm or Seek Consent
- “Has [patient] mentioned they’re happy for us to discuss their care with you?”
- “Do you have written consent or a lasting power of attorney?”
- “Could we call [patient] now, or arrange a joint appointment?”
Step 5: Set Expectations
| ✅ MANAGING EXPECTATIONS | Doctor: Without seeing [patient] directly, there are limits to the clinical decisions I can make today. What I can do is listen, make a note, and arrange for them to come in so we can address this properly. |
Step 6: Provide General Information
- “I can’t discuss specifics, but I can tell you generally about how dementia is assessed — would that help?”
- “There are excellent support organisations for carers. Let me give you some information.”
Special Scenarios
DNACPR / End of Life: Be compassionate but clear that these decisions involve the patient (if they have capacity) and the clinical team.
Safeguarding: If the relative discloses abuse or risk of harm, your duty of care may override confidentiality.
Parent of adult child: Handle with sensitivity: “As an adult, [patient] has the right to manage their own healthcare, but I can see how much you care.”
Step 7: Close Respectfully
| ✅ GOOD EXAMPLE: “Thank you for taking the time to come and talk to me. I’ll make a note and encourage [patient] to come in so we can take things forward together.” |
| ⭐ KEY POINT: Relative consultations test three things simultaneously: (1) you understand confidentiality law, (2) you can still be warm and helpful within those boundaries, (3) you manage expectations while protecting patient autonomy. |