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Inside information

Confidentiality: in the form of gossip, a great deal of recreation derives from its flouting. For doctors, in contrast, it’s second nature to protect information, and piously reinforce the sixth pillar of clinical governance.

But then, we’re in a privileged position. Not for us the experience of sitting in an outpatient waiting room, seething with inquisitiveness, trying to work out ‘what has he come in with?’ Within a couple of hours, a doctor might know the intimate details of everyone in that room.

The problem with being knowledge-rich, however, is how frustrating it is when you are kept in the dark. To keep up my clinical skills during a foundation year 2 rotation in public health, I’ve been shadowing a prison GP. My supervisor briefed me about the inmates as we walked across the concrete compound after my first day.

‘The prison has about a thousand inmates,’ she breezed. ‘Those who’d be vulnerable in the main prison system.’

The briefing changed tack, but I was already wondering why these prisoners were vulnerable (not to mention what they’d be vulnerable to).

Later, we were drinking tea in the clinic room as she looked up the first patient’s records.

‘Ah. Not to be alone with this one.’

I paused, rather hoping she’d go on. There was no opportunity for elaboration, however, before a benign looking 60-year-old entered and sat himself down for a medication review on the side of the doctor’s desk furthest from the door. I was consumed with curiosity: why not alone? What crime had he committed? What provoked the act that led to incarceration?

‘About half the prisoners are rapists,’ said the GP after he’d gone. ‘And the other half are paedophiles.’

So this was the elephant in the room. Each time a patient came in, I found it hard to stop speculating on which of the heinous cohorts he might belong to. Instead of concentrating on my supervisor’s history-taking, or scrutinising the patient for stigmata of disease, my thoughts were sidetracked by what was very obviously not being said. What a relief it was when a more garrulous offender volunteered the full (and not very nice) cause of his confinement, and I could concentrate again.

Professionalism dictates that we treat those in need without prejudice, but I don’t think that issue was compromised here. Rather, I was struck by how blasé we become about information when we feel entitled to it. Confidentiality has its place, but perhaps the wise patient gets everything out in the open. There’s nothing less interesting than stale gossip.

Nottingham foundation doctor 2 in public health Graham Stevenson

Confidentiality and health records

As a doctor, increasingly complex dilemmas can arise from your duty to protect patient confidentiality.

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