Medical confidentiality Q

scrimshanker

So I go see a psychiatrist and I'm told about confidentiality and that they only have to disclose something I say if there's a serious threat to me or to someone else. That if I mention anything about abuse etc., they will be obliged to report if I name the person or if I provide enough detail to identify them. Okay, that's fine.

I disclose past abuse that happened when I was a minor. I don't give identifying details or names.

Now today I get a call and I'm told that child protection guidelines changed, and that it actually does have to be reported and the person to whom it's reported will try to convince me to disclose the name.

I'm fuming.

I only disclosed it under the information I was given, which was that I would NOT be forced to give a name and they would NOT report it if I didn't give a name.

If they had said that any abuse had to be reported I would never, ever, ever have mentioned it.

Where do I stand legally? Can I prevent them from going any further with this?

Gongoozler

It's because they've deemed it necessary, because they think there's a chance that others are at harm from that same person.

scrimshanker

Gongoozler wrote: »

It's because they've deemed it necessary, because they think there's a chance that others are at harm from that same person.

I know that, my point is where do I stand with the fact that I don't believe it was an informed disclosure...

Gongoozler

scrimshanker wrote: »

I know that, my point is where do I stand with the fact that I don't believe it was an informed disclosure...

I don't think it matters, I don't know that there's such a thing as informed disclosure.

My point is the psychiatrist has deemed someone else to possibly be in danger, and that is more important than your right to confidentially.

scrimshanker

Gongoozler wrote: »

I don't think it matters, I don't know that there's such a thing as informed disclosure.

My point is the psychiatrist has deemed someone else to possibly be in danger, and that is more important than your right to confidentially.

They've already told me they're reporting it because the guidelines changed. They weren't going to report it otherwise.

Gongoozler

Well, you can't untell him. He has an obligation to report it. I don't know what you're looking for here. Are you looking to sue him? If you're worried about the guards coming to you, I suppose they could but I don't know that Irish law is equipped to deal with forcing you to disclose. Though I'm not sure on that.

jjC123

The possibility of someone harming a child trumps confidentiality every time. Doctors, psychiatrists in particular, take confidentiality incredibly seriously. Its the first thing they're warned about on day 1 of med school so I doubt the decision to report was taken lightly.

You could pursue legal action but the psychiatrist is probably on the right side of the law here. I'm sorry if this has put you in a distressing situation but I'm sure your psychiatrist did it for all the right reasons.

Manach

I'd be inclined to agree with OP. My reasoning is in part based AFAIR from a book on medical ethics by Tony Hope.
There are various duties of care, but the primary focus of the professional had been the actual person to whom they are involved - this would be reflected in parts of the original classical Hippocratic oath ( ... complete comfidence). By this mutablility of guidelines ( which admittedly serves an important aim)to uncover potenital threats both causes actual distress to any current patients and would serve as a block to other's seeking help. If this guidelines is so changible, patient autonomy and the respect of their wants is just an unsupported wish instead of right.

One eyed Jack

Manach wrote: »

I'd be inclined to agree with OP. My reasoning is in part based AFAIR from a book on medical ethics by Tony Hope.
There are various duties of care, but the primary focus of the professional had been the actual person to whom they are involved - this would be reflected in parts of the original classical Hippocratic oath ( ... complete comfidence). By this mutablility of guidelines ( which admittedly serves an important aim)to uncover potenital threats both causes actual distress to any current patients and would serve as a block to other's seeking help. If this guidelines is so changible, patient autonomy and the respect of their wants is just an unsupported wish instead of right.

Does a professional code of ethics supercede the law?

scrimshanker

One eyed Jack wrote: »

Does a professional code of ethics supercede the law?

Surely a threat has to be actual and specific, can't just be a vague potential threat to unknown people in order to breech confidentiality?

Plus, surely if I was told I would be treated under X conditions, it's unfair to retrospectively apply Y conditions given that I wouldn't consent to treatment under Y conditions.

One eyed Jack

scrimshanker wrote: »

Surely a threat has to be actual and specific, can't just be a vague potential threat to unknown people in order to breech confidentiality?

Plus, surely if I was told I would be treated under X conditions, it's unfair to retrospectively apply Y conditions given that I wouldn't consent to treatment under Y conditions.

I'd be reluctant to comment on your case specifically tbh as I'd be veering into legal advice territory as opposed to legal discussion, which is why I asked Manach specifically in relation to confidentiality and the laws regarding child protection, disclosure of information, and whether a professional code of ethics should supercede the law.

As far as I'm aware, it doesn't.

Manach

One eyed Jack wrote: »

Does a professional code of ethics supercede the law?

You are asking a rhetoric question in part because the law has the full power of the state behind it. If you asked perhaps a more open question that would be more in line with the core query: should the duty of care that is inherent in such ethics allow the practicioner to rely on his/her own judgement to decide which path leads to least harm on a case by case basis instead of relying on the blunt instrument that is law?

One eyed Jack

Manach wrote: »

You are asking a rhetoric question in part because the law has the full power of the state behind it. If you asked perhaps a more open question that would be more in line with the core query: should the duty of care that is inherent in such ethics allow the practicioner to rely on his/her own judgement to decide which path leads to least harm on a case by case basis instead of relying on the blunt instrument that is law?

I should have phrased it differently because I was wondering moreso if they are bound by the law to disclose information, that they then couldn't use any professional code of ethics to avoid disclosure.

Somewhat similar to contract or employment law in the way that anything written into a contract is superceded by law.

Ken.

Personally I'd be putting in a call to the governing body of psychiatrist's and ask them what the story is. Not sure if they are the same as doctors and can get struck off if they mess up but worth a call anyway I think.

Edit to add
I'd say contacting one of these and explaining your case will set you on the right path.

http://www.irishpsychiatry.ie/Utilities/ContactUs.aspx

Lorna O’Callaghan
Professional
Competence Manager
01-6344375
pcs@irishpsychiatry.ie

Mona McCormac
Professional Competence Officer
01-6344378
mona@irishpsychiatry.ie

Louise Bunyan
Professional
Competence Administrator
01-6618450
louise@irishpsychiatry.ie

Gongoozler

There is the law, and there is a code of ethics. Any code of ethics is not legally binding, but seen as an additional layer of rules for a profession. You may be punished by your regulatory body for something that isn't illegal.

Professional competence is about cpd and not relevant to this.

Psychiatrists are regulated by the Medical Council, same as other medical practitioners. But believe me when I say you will not get advice from the Medical Council on this.

_Whimsical_

Manach wrote: »

I'd be inclined to agree with OP. My reasoning is in part based AFAIR from a book on medical ethics by Tony Hope.
There are various duties of care, but the primary focus of the professional had been the actual person to whom they are involved - this would be reflected in parts of the original classical Hippocratic oath ( ... complete comfidence). By this mutablility of guidelines ( which admittedly serves an important aim)to uncover potenital threats both causes actual distress to any current patients and would serve as a block to other's seeking help. If this guidelines is so changible, patient autonomy and the respect of their wants is just an unsupported wish instead of right.

I would also agree with this and the OPs initial reaction. If the OP discussed a current threat to children that would be a different matter. If rules were to change like this it would surely prevent people being able to so much as discuss their abuse with any professional with an end to coping etc. It would seem very wrong to take any means of support from abuse victims. It could hugely impede a person's medical treatment for mental illness if they could not disclose previous abuse too.

Fred Swanson

This post has been deleted.

steddyeddy

scrimshanker wrote: »

I know that, my point is where do I stand with the fact that I don't believe it was an informed disclosure...

Is the person still a threat to children? That's the most important question you have to answer. I have an inkling of what you're going through OP but I think if a child was at risk that should be everyone's first concern.

How long ago did your doctor tell you anything you said would be in confidence? Usually they do tell you they have to act if someone is in danger.

steddyeddy

scrimshanker wrote: »

Surely a threat has to be actual and specific, can't just be a vague potential threat to unknown people in order to breech confidentiality?

Plus, surely if I was told I would be treated under X conditions, it's unfair to retrospectively apply Y conditions given that I wouldn't consent to treatment under Y conditions.

A child abuser in close proximity to children is not a vague threat.

scrimshanker

steddyeddy wrote: »

Is the person still a threat to children? That's the most important question you have to answer. I have an inkling of what you're going through OP but I think if a child was at risk that should be everyone's first concern.

How long ago did your doctor tell you anything you said would be in confidence? Usually they do tell you they have to act if someone is in danger.

I have only seen that doctor once so it was same session. Even after I talked about it, I was told that it would be reported if I named him, and I was asked if I would like it to be reported. Can't see that the doctor saw what I said as indicating that anyone is at risk seeing as she wasn't going to report it in the first place.

steddyeddy

scrimshanker wrote: »

I have only seen that doctor once so it was same session. Even after I talked about it, I was told that it would be reported if I named him, and I was asked if I would like it to be reported. Can't see that the doctor saw what I said as indicating that anyone is at risk seeing as she wasn't going to report it in the first place.

TBH it sounds like the doctor might have made an balls of telling you the guidelines in the first place. Usually they do say if something you say gives us cause to think that someone (including you) is in danger we have to act. They don't necessarily need the name but they certainly need something. Are you worried this person might find out and things would be worse for you?

Gongoozler

I know from personal experience that the standard is they tell you that they have to disclose if you are a threat to yourself or someone else, or if you say something that means someone else might be in danger.

OP if you Google disclosures allowed under section 8 of the data protection act, you'll see that it's pretty standard.