ABSTRACT
The first, and most easily recognised exception is when the patient or his legal adviser consents to a relaxation of secrecy. The situation is simple when viewed from the positive angle: a positive consent to release of information elides any obligation to secrecy owed by the person receiving that consent. Equally, an explicit request that information should not be disclosed is binding on the doctor save in the most exceptional circumstances …
Looked at from the negative aspect, however, the position is not so clear and may be frankly unsatisfactory. How many patients know whether the person standing with the consultant beside the hospital bedside is another doctor, social worker or just an interested spectator? Would they have consented to their presence if they had been informed? The consultant may be responsible if, as a result, there is a breach of confidence – but this is small consolation to the patient who feels his rights have been infringed. What patient at a teaching hospital outpatient department is likely to refuse when the consultant asks, ‘You don’t mind these young doctors being present do you?’ The pressures are virtually irresistible and truly autonomous consent is impossible, yet the confidential doctor-patient relationship which began with his general practitioner has, effectively, been broken.
