A disclosure dilemma

A newly qualified GP saw a 70-year old man for a medication review. The patient had type 2 diabetes and early-stage vascular dementia but was still living independently with help from his wife. During the appointment, the patient confided that he was still driving and vowed he would never voluntarily give up his license.

The GP was concerned about the risk the patient might represent to other road users as his disease progressed, so she contacted the DVLA’s medical advisers for confidential advice.

On the basis of this advice, the GP explained to the patient that he had a legal responsibility to inform the DVLA as his dementia may impair his ability to drive. She tried to reassure him that this wouldn’t automatically mean he would be disqualified from driving, but warned that doing nothing might affect his insurance cover and risk a fine. The patient promised he would notify the DVLA and the GP explained how he could do this.

A week later, the practice receptionist told the GP she had seen the patient make several attempts to park while she was on her way to work. When the GP called, the patient blamed narrow parking spaces but admitted he had not yet ‘got around’ to notifying the DVLA. At this point, the GP advised she had a duty to report the matter if he would not, because he was putting the public at risk.

The patient was upset but after talking to his wife, he agreed to notify the DVLA himself. Once notified, the DVLA made contact with the practice for further information on his condition. This was provided, with the patient’s consent, and following a driving assessment he was allowed to keep his license subject to annual review.

MDU advice

• Doctors owe patients a duty of confidentiality, but it might be necessary to disclose information about a patient, even without their consent, to protect individuals or the wider public from serious harm - for example, if you suspect a child is at risk.
• You must be able to justify disclosures in the public interest, particularly if they are made without the patient’s consent. Seek advice and keep a careful record of any discussions with the patient and decision-making process.
• Keep such disclosures of identifiable information to the minimum necessary and be sure not to compromise the confidentiality of others.