Disclosure or confidentiality?

Issues around disclosure of information pose many dilemmas for health care workers. The biggest comes in relation to the question: ‘If I disclose this information, will I be breaching patient/client confidentiality?’

The answer is that in exceptional circumstances, you may over-ride your duty of confidentiality to patients/clients if it is done to protect their best interests or the best interests of the public. If you have information that suggests a patient/client is either at risk of harm or is posing a risk of causing harm to someone else, you should report your concerns to your manager or supervisor and contribute to actions to reduce the risk of harm.

But sometimes issues around disclosure and confidentiality might not be clear-cut, and the boundaries of good practice might seem blurred. You should always seek advice from your manager/supervisor or a senior colleague at work if an issue around disclosure or confidentiality arises in your practice.

Take a look at the following scenarios and see how following a different course of action can lead to very different outcomes.

Scenario 1

You are assisting an older woman to have a shower in her own home when you notice that she has quite severe fresh bruising on her back and upper arms. The woman is initially reluctant to speak about the cause, but eventually tells you that her middle-aged son, who lives with her, inflicted the bruises.

He can become violent when he has been drinking, she explains, but ‘he always manages to cause the bruises on parts that aren’t exposed so that no one can see them’. You are very concerned about the woman’s safety, but she pleads with you not to tell anyone as she is embarrassed and doesn’t want any shame to fall on her son.

You have a clear conflict here. You feel that the best course of action is to report your findings immediately to your manager, who will be able to alert the appropriate authorities, and then write a formal report as a record of what happened. But you’re worried that doing so would breach the woman’s confidentiality.

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You explain to the woman that while you understand her anxiety, she doesn’t have to stand for the assaults, and you will be able to put her in touch with people who can help.

Confident that you are acting in the woman’s best interests and within the terms of the Public Interest Disclosure Act, which over-rides your duty to protect her confidentiality, you contact your manager and report what you have found.

Your manager commences procedures to protect the woman, while you return to your work base and compile a report of your findings and the action you took.

Take action

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You decide that even though you are worried about her safety, you would be breaching her confidentiality if you disclosed your concerns to your manager.

You report that the woman had a shower and nothing abnormal was detected.

You reflect back on the day at home and find you can’t stop worrying that the woman is perhaps facing another assault.

You realise there is no one you can talk to about your worries.

Take no action

Scenario 2

You are assisting an older woman to have a shower in your care home, when you notice that she has quite severe bruising on her upper arms – it looks like someone has squeezed the arms very tightly. The woman is initially reluctant to speak about the cause, but eventually tells you that the nurse who showered her a few days ago inflicted the bruises. The nurse is always very irritable when she is with the woman, she explains, because ‘she says I’m far too slow and need a pinch to speed me up.’ You are very concerned about the woman’s safety, but she pleads with you not to tell anyone as she is embarrassed and doesn’t want the nurse to get into trouble for fear that it would only make matters worse for herself.

You have a clear conflict here. You feel that the best course of action is to report your findings immediately to your manager, who will be able to set the appropriate procedures in motion, and then write a formal report as a record of what happened. But you’re worried that doing so would breach the woman’s confidentiality.

So what do you do?

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You explain to the woman that while you understand her anxiety, she doesn’t have to stand for the assault, and the care home will be able to protect her.

Confident that you are acting in the woman’s best interests and within the terms of the Public Interest Disclosure Act, which over-rides your duty to protect her confidentiality, you go immediately to your manager and report what you have found.

Your manager commences an investigation into the woman’s claims while you compile a report of your findings and the action you took.

Take action

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You decide that even though you are worried about her safety, you would be breaching her confidentiality if you disclosed your concerns to your manager.

You report that the woman had a shower and nothing abnormal was detected.

You reflect back on the day at home and find you can’t stop worrying that maybe the nurse in question is assaulting other residents in a similar way.

You realise there is no one you can talk to about your worries.

Take no action

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