When to make it a family matter

12 April 2010

Doctors may occasionally need to disclose information about a diagnosed inherited condition to members of a patient’s family, against the patient’s wishes, says the MDU today.

In the latest issue of Ward Round1, the MDU Journal for foundation year doctors, medico-legal adviser, Dr Kathryn Leask explains:

"As more genetic tests are developed to help confirm or rule out suspected inherited disorders, it's increasingly likely that doctors will need to talk to patients about disclosing their diagnosis with others who may be affected. Patients are generally happy to allow their doctor to disclose the information to at-risk relatives, especially if screening and pre-emptive treatment can be offered, such as with some breast and bowel cancers; or if the condition, such as Huntington's disease, may influence a decision to have children.

"Occasionally, however, the patient may refuse, perhaps because they are embarrassed or they do not wish to upset their relatives. In these sensitive cases, doctors will need to need to be aware of their ethical obligations in this area, as set out recently by the GMC and balance the patient's right to confidentiality against potential harm to family members if they are not informed."

Using clinical scenarios, the article outlines some of the considerations for doctors in deciding whether to disclose information to the patient's family, without their patients' consent, including:

When deciding whether family members should be informed, consider the number of people at risk of the diagnosis, the seriousness of the condition and the fact that screening and/or prophylactic surgery may be available.

Be open with patients about what you think it necessary to tell their families and provide all the information necessary about their condition to enable them to make an informed decision.

If doctors decide to breach confidentiality, they need to let patients know what they intend to do and why. This may even be enough to change patients' minds.

Keep detailed records of the reason why you consider information should be disclosed and any discussions with patients.

Elsewhere in Ward Round Dr Sally Old considers how to maintain patient confidentiality and avoid common pitfalls when communicating with a patient's family; while Dr Emma Cuzner examines three confidentiality dilemmas facing hospital doctors, based on calls to the MDU's advisory helpline.

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