Confidentiality is one of the key factors which encourages a good patient – doctor relationship and is laid out in the GMC’s document of Good Medical Practice. It involves keeping a patient’s records and information safe to ensure that it is private, and only visible to those who are authorized including healthcare worker colleagues who require it for the care of the patient. In the case of asking advice from colleagues who have no role in the care of a patient, doctors are encouraged to keep them anonymous wherever possible. Maintaining confidentiality when possible is of paramount importance. However, there are certain cases where confidentiality may be broken, for example, where harm will be caused to someone else if confidentiality is retained. In these cases, it is required by law that confidentiality is broken in order to keep others safe.
Almost all questions about confidentiality will surround a case presented to you in the interview. You may then be asked about how you would proceed on a certain case, whether you would break confidentiality, and how you would do so. You may also be asked to make a judgement on other ways of addressing issues without breaking confidentiality, although these are slightly rarer.
The most important first step when given a scenario is to consider all options available, and talk them through, remembering to include their consequences. Another good point to mention in your answer would be the medical ethics principle of autonomy: patients have the right to decide their own treatment, and breaking confidentiality perhaps detracts from this. Another point to be aware about is the negative impact breaking confidentiality will have on the patient – doctor relationship: the patient may no longer trust the doctor and so may not confide in them. The judgement of whether this is a worthy price to pay is up to you to decide, and as with most scenarios, you must show that you are weighing up different arguments in order to come to a coherent decision. Do remember, however, that the law requires a doctor to break confidentiality if potential harm could come to others. This will show the interviewer that you are able to consider multiple points of view to make a decision.Do remember, however, that the law requires a doctor to break confidentiality if potential harm could come to others.
Confidentiality is most often a topic which comes up when discussing a case.Therefore it is very rarely, if ever, questioned in isolation, so its use in a medical school interview depends entirely on the interviewer’s choice of scenario. That is not to say, however, that these questions are uncommon. They tend to come up relatively often in the MMI format, although slightly less often in panel interviews. If the issue of confidentiality does come up, as long as you keep in mind the laws about breaching confidentiality and use reasonable judgement, you will likely score well in this important and interesting topic.
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