Would a Blog Create a Breach of Trust?

Question: I am thinking of starting a blog to record my experiences as an FY1 doctor, as I think it would be interesting for medical students to know what to expect when they qualify. I wanted to include anonymised descriptions of some of my more interesting patients, but one of my colleagues told me I could get into trouble if I don't get their consent. Should I go ahead?

Answer: Confidentiality is central to trust between doctors and patients, and respecting patients' right to confidentiality is one of your core duties as a doctor. Without proper assurances about confidentiality, patients may be reluctant to give doctors the information needed to provide good patient care. The fact that you are planning to write up the more interesting cases increases the likelihood that the details will be identifiable in some way, even if you attempt to anonymise them.

In its Frequently Asked Questions publication that accompanies its core 2004 guidance on confidentiality, the General Medical Council (GMC) says: "It is very difficult to anonymise case studies fully, especially if they are of interest because they deal with a rare condition, or the detailed history of a patient with mental illness. For this reason, you must obtain express consent from patients before publishing personal information about them as individuals in media to which the public has access ... whether or not you believe the patient can be identified. Express consent must therefore be sought to the publication of, for example, case-histories about, or photographs of, patients."

When obtaining consent, you must make sure that patients are given enough information on which to base their decision, including how much information will be disclosed and to whom, the reason for the disclosure, and any likely consequences. It may be safest to let patients see, and expressly agree (subject to necessary amendments), the exact text that is intended to be used.
If you include details that could identify a patient to a third party without first obtaining consent from the patient, then you will have breached your duty of confidentiality, even if this was not your intention. If a patient finds out and makes a complaint about a breach of confidentiality on your blog, you risk disciplinary action by your trust or the GMC, and it may be difficult to justify your actions in accordance with the GMC's confidentiality guidance.

Dr Norwell, Medico-legal adviser at the Medical Defence Union.

I will take this advise and so should you....