Patient concerns – confidentiality

You are a junior doctor working in general practice. Martha Roberts, a 43 year old, has come in to see you. Please address her concerns. You have 8 minutes.

Your role

You are Martha Roberts. You are 42. You have come in to the general practice surgery to discuss ‘an embarrassing problem’.

Demeanour: You are a female of high-socioeconomic class. You are well-spoken and can be quite pushy.

Scenario

You had an argument with your husband (also a patient at the same practice) a week ago. You went out drinking with your girlfriends that evening and regrettably had unprotected sex with another man you knew from your old workplace. For 3 days ago, you have been experiencing discharge ‘from down below’. You think you have a sexually transmitted infection and would like some antibiotics.

Request that the doctor does not write any notes on the consultation. If asked why, admit that your husband plays golf with Dr Rodgers (one of the partners) and you do not want your husband to know. They are really good friends and you are sure he would tell your husband, despite what the doctor says about confidentiality. If the doctor says he has to make notes, ask what else can be done to protect you? Can he use a fake name?

If the doctor suggests you tell your husband, say you do not want to do this because he won’t take it well and it is never going to happen again so it will cause him unnecessary pain. You are very regretful about cheating on him. If the doctor suggests that he needs treatment as he may be infected (or you may be re-infected), ask if you can take some antibiotics for him too and you can put it in his food. Or could the doctor give him the antibiotics and tell him they are for something else?

If the doctor persuades you that your husband’s health may be significantly at risk and this is done in a respectful, non-judgemental manner, then eventually agree that you will talk to him as you would not risk his health.

If asked specifically, you have had unprotected sex with your husband since cheating on him.

Background information

You have no medical problems and only take the oral contraceptive pill. You live at home with your husband. You are happily married and have never cheated on him before and would never do it again. You have 2 grown up children. You are quite wealthy and do not need to work. You enjoy going out for lunches and regularly go out drinking with your girlfriends. You drink about 5 bottles of wine in total per week. You do not smoke.

Questions for the doctor

As above.

Category	Question	Done	Excellent
Introduction	Candidate appropriately introduced themselves with: Full name Role Checks patient details Asks patient for preferred name
Introduction	Further introduction Gains consent for consultation Mentions confidentiality
Information gathering	Gathers information appropriately Gathers information sensitively Checks symptoms Reviews sexual history Considers contact tracing Determines if her husband has been put at risk
Communication	Communication expectations Non-judgemental Builds rapport Listen to patient concerns and suggest options
Ethics	Ethical expectations Agree to confidentiality i.e. not telling the husband without her consent (would be different for BBVs) Tries to persuade the patient to tell her husband as he has been put at risk Effectively explains why this is necessary Offers possible solutions e.g. offer to meet with them both together or send an anonymous letter Must not give antibiotics to the patient to give to her husband covertly Does not agree to lie to husband Doctor has to write in the patient’s notes if he/she does any tests or prescribes treatment Doctor could suggest the option of her going to a sexual health clinic to have the tests were it would be separate from the GP record and she would not have to give her real name
Closing	Closing consultation Makes appropriate arrangements for follow up Thanks patient
Patient	Patient score Good rapport with patient Active listening skills Appropriate use of body language Avoids medical jargon Summarises and checks patient understanding