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confidentiality

4 posts in this topic

A patient with psychotic depression is detained in the ward.he has attacked someone with the knife before admission.police want to interview him and asks you what he has told you.how will you manag?

This is discussed earlier,however i am not sure!!!!!!!!!!

A teacher who has become more sexually demanding and paranoid towards her fellow teachers.woud you break confidentiality and warn the other teacher if thete is signifiacant risk/

according to oxford handbook

--you can if there is significant risk of death or serious harm.

Does the above PMPs fall into this catogory where confidentiality can be broken?

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3 times when you consider disclosure of information

1. If the patient asks you to.. and gives consent

2. If the court asks you to

3. If there is some concerns about vulnerability and protection (of the patient or others)

All 3 cases, ask for a written request from the person asking...

Be very specific

Give the necessary minimum...

It is the requesting person's role to get the consent...

In any case we have to tell the patient that we are disclosing...

Documentation to be very clear...

Please correct me if I am wrong.

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You have to tell patient you are disclosing, unless it would compromise the results of disclosing- eg put someone at higher risk, or compromise a court case, for example.

I think in the first case, the patient is admitted, ie not a current risk to others. Therefore, assess if he is fit to be interviewed by police (ie has capacity). With regard to them asking for confidential info from you, given that no-one is currently at risk, I would suggest they get a court order. You could ask the patient if he consents to you giving info to police, but be specific and document the conversation. Also, assess his capacity to give consent...if he says 'yes you can talk to police, I deserve to be punished', I would wonder  ;)- if incapacitous, you can't use it.

Teacher-depends on level of risk that you feel exists, which needs thorough assessment of previous history, fantasies, plans, mental state (delusions, hallucinations, obsessions, insight) etc.

Someone who is fantasizing about a colleague but with good insight and no plans, you'd be wrong to disclose. Someone who is delusional about a perceived infidelity and has plans to go there with a knife and has just absconded from ward- obviously you'd have to disclose. In between- discuss with colleagues and defence organisation if necessary. And document it.

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If is doubt always ask the trust solicitor

ask MDU for opinion... they have a 24 hour helpline

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