The fringes of confidentiality

Mr Edwards has come for help with his body odour. Having tried a wide range of products and hygiene regimens, he wonders whether I may be able to provide a diagnosis, or better still, a solution. I am curious; he has always smelled fine to me.

'How do you know you have body odour?'

'Well I don’t smell it, but my wife reminds me of it almost every day'.

A light dawns. Mrs Edwards suffers from intractable sinusitis; she sees me for it several times per year. How clever I will look when I tell her husband that the problem may not be with him at all.

Another light, this time a red, flashing one, with accompanying tannoyed voice exclaiming 'confidentiality breach warning'. Some quick thinking required here.

To the very best of my knowledge, the two of them have no secrets regarding their health. They frequently sit in on each others consultations, and seem to talk to me just as freely as a couple as when seen individually. I am reasonably confident that Mr Edwards has been present for at least one of the discussions that his wife and I have had about her sinuses, and she is on a range of medications for the problem, so I would find it most surprising if he were not already aware of it. Even so,  to discuss her diagnosis with him without her expressed permission might conceivably be to undermine a central tenet of my profession.

This sort of dilemma comes up all too frequently. Parents ring up for their teenagers’ swab results having been present at the sore throat consultation the previous week. A family member translates for a non-English-speaking patient and there is simply no opportunity to find out from the patient whether or not it is acceptable to refer to the potential significance of a pre-existing health condition in the present illness.

So what do we do? Speaking for myself and the GPs I work with, sometimes we chance it. If all the available evidence indicates that the patient would have no objections, if the potential for harm seems small, and if keeping silent is likely to cause problems for the families involved, then on occasions the letter of the code is breached. Mr Edwards’ body odour was such an occasion, and the appreciative Christmas cards from the two of them have continued since.

I believe that the principle of patient confidentiality should be upheld as paramount, and like all GPs I frequently decline relatives’ requests for information until I have been able to clear it with the patient, but cases like this fill me with uncertainty nonetheless. Should I change my practice and become ultra-cautious? The views of this site’s readership would certainly be appreciated.