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To disclose or not to disclose? That is the question

As human beings, we have all been in circumstances where we need to have a conversation with someone that we’d rather not: telling a relative that we’re worried about them, perhaps, or having a tricky discussion about performance with someone who works for us. They’re difficult conversations to have – but someone has to do it.

Our registrants (as well as other healthcare professionals), have an added layer of exposure to these difficult conversations by the nature of their role in protecting the public. As a result of this role, they tend to be trusted and this trust means that they are privy to all kinds of information about their patients. In the vast majority of circumstances, this information must be kept confidential. When this information affects more than just the patient and that information needs to be passed on for public safety/interest reasons, however, then difficult decisions need to be taken and conversations need to be had.

I’m a registrant. What does this mean for me?

Unsurprisingly, you – our registrants – have been telling us for some time that you find this part of your role tough. Research we undertook in 2017 showed that 56% of registrants found it difficult to balance their duty of confidentiality with their duty to protect the public. With this in mind, we have published some supporting guidance for registrants on disclosing confidential information about patients. There is a focus on disclosing information about patients who may no longer be safe to drive – a relatively common scenario in optical practice – but also guidance on other scenarios where confidential information might need to be passed on to others. The guidance itself doesn’t create any new requirements but aims to clarify what the GOC’s expectations are in relation to the balance between duties of confidentiality and public protection, with a view to maintaining the trust that exists between patient and practitioner as much as possible. For more information about how we created the guidance, see our recent press release.

The guidance won’t tell you exactly what to do in each situation because we recognise that each case is different and that you, as the healthcare professional working with the patient, are in the best position to make that decision. It should, however, give you some idea as to the thought process you should follow to make sure that you’re confident in the decision you make.

In some circumstances, it may be that you don’t need to disclose at all because the patient voluntarily makes the disclosure themselves; this is where having those difficult conversations can be useful. It won’t always be appropriate to do so (see the guidance for examples of where it would not be) but where it is, talking to the patient about your responsibilities as well as their own can be very helpful and may help to maintain trust between you. This could be particularly useful where the information to be disclosed is in relation to a patient’s fitness to drive, as the legal responsibility to inform the DVLA/DVA about this actually rests with the patient. Having that conversation could also provide an opportunity to direct the patient to valuable (and appreciated) further information and support.

If, after you’ve looked at the guidance, you’re still unsure, don’t be afraid to seek further advice and support for yourself; you could discuss your decision with your employer, a senior colleague, a professional/representative body or your insurer. Remember that employers have a key role to play in making sure that you can make the decision to disclose where you believe there’s a public interest reason to do so – it’s required of them as part of our Standards for Optical Businesses – and so they should be a valuable source of support.

We really hope that the guidance is useful to you and clarifies what you should be thinking about in situations regarding disclosure of confidential information, whether you are an individual or a business registrant. Any feedback – including suggestions on how we can further raise awareness of the guidance – would be very much appreciated. You can get in touch with us at standards@optical.org.

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