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US0650 Health Studies Question: Case Study: Mr Andrew Johnson visits his local sexual health clinic with concerns that he may have contracted chlamydia. Mr Johnson has recently separated from his wife, who is pregnant with his child, and he currently has a new partner. The sexual health clinic routinely recommends a full sexual health screen including syphilis and HIV testing. The tests are explained to Mr Johnson and he decides that he would like to proceed with the tests. The results confirm that Mr Johnson does have chlamydia. The HIV test is also positive. Mr Johnson is then seen by Dr Hope, who confirms the test results and offers medical advice regarding treatment of both conditions. Dr Hope advises Mr Johnson that he would like to forward the results to his GP, so that treatment can be fully discussed and continued. Mr Johnson refuses consent for his GP to be notified as he is worried about discrimination. Dr Hope also advises that Mr Johnson should inform his previous and current sexual partners of both the chlamydia, and his HIV status. Mr Johnson agrees to tell his current partner about the chlamydia, but not the HIV. He refuses to inform his pregnant wife, who he has recently separated from, of either condition. You should identify and analyse the issues surrounding confidentiality within this case study. Use the Data Protection Act and a suitable Working Code of Ethics to analyse if the patient’s confidentiality should be protected or not in this situation. Answer: The aspect of confidentiality is highly respected in the medical profession. This is alongside work ethics and professional standards that medical practitioners work with. In addition, the Data Protection Act 2018 plays a significant role when it comes to confidentiality.  In the year 2009, the General Medicine Council published supplementary guidance and general guidance on “Disclosing Information about Serious Communicable Diseases.”  It is also worth noting that confidentiality is taken to be an ethical and legal duty. It is a good practice to establish trust between a doctor and his patient so that information being provided is tangible and sufficient. Also, information can be disclosed when a court order is issued. The most important element to be put into consideration is the patient’s consent. A doctor must seek consent first form the patient before he or she discloses the information to a third party, (Papoutsi et al., 2018, 312). As such, reasons for the consent to deny consent have to be understood by the doctor. However, in a situation where others may face risks because of the underlying conditions, doctors may be justified when they disclose information- only in exceptional cases. In making this consideration, the patient’s interests must be outweighed by the public or individuals’ interests which may be detrimental to their health. The General Medical Council provides a clear guideline on how information can be protected from improper disclosure, (St. John et al., 2017, 191). The guideline state that any information that a practitioner holds, about a patient. Should be effectively protected. In case the information is disclosed, one has to keep the disclosures to the minimal levels as possible. This can be in situations where a laboratory expert gets the information and relays it to the patient’s doctor. Personal genealogical practitioners may also be given the results. Therefore, disclosure should be made also after seeking consent from the patient. In situations where the patient is not willing to disclose the information or medical condition to close people such as a wife or sexual partner, the doctor and the patient should arrive at a compromise by giving clear explanations to the patient about the possible consequences his partners may face. Knowledge of how they can protect their sexual partners should also be transferred to the patient. In the scenario at hand, D. Hope may be considered to have breached confidentiality after forwarding the results to the patient’s Genealogical practitioner especially after failing to seek consent from him. However, these are the issues at hand Whether Dr. Hope Will Breach Confidentiality By Forwarding The Results To Mr. Johnson’s GP In this scenario, Mr. Johnson has denied Dr. Hope the consent to forward the results to his personal doctor. Johnson has all the rights to deny consent despite the fact that the results are forwarded with good intention. In this scenario, doctors have the duty of getting the best help and advice for their clients. As such, forwarding the results may not seem like a bad idea although the patient is not willing to do so. He fears that he will suffer discrimination, (O’Brien et al., 2017, 12). Under the Data Protection Act, Dr. Hope has the duty of maintaining confidentiality between him and his client. Whether Mr. Johnson should inform his previous and current sexual partners of both the chlamydia and his HIV status Mr. Johnson has the duty of ensuring that those close to him are safe. This relates to the sexual partners he has. In most cases, partners are encouraged to know their health conditions together so that they can have healthy children. He also has a pregnant wife and this necessitates his action of informing her as long as they are in good terms. On the other hand, Johnson can still maintain his silence. However, doctors have the responsibility of taking care of other people’s lives. This creates a situation of dilemma especially when a baby is being expected. To avoid liability, this is a scenario where the doctor has to break disclosure and inform Johnson’s wife, or he can encourage him to inform her. The General Medical Council has a clear set of Codes of Conduct that its members have to abide by. For example, medical professionals are supposed to perform their duties with integrity, honesty, and loyalty, (Paul et al., 2017, 10). This entails the adherence of consent between them and their clients. In the event that there are issues that are not clearly understood, members have the duty of informing the medical council instead of creating their own solutions. The British Medical Association has also set guidelines for medical practitioners. The Code of Practise is used by its members while carrying out their duties, especially doctors who are undergoing training, (Wong et al., 2018, 731). In this case, doctors are required to provide quality information during practice. According to the Code of Conduct, Chapter 2, doctors can be referred to as controllers because they have the patient’s information and it is their duty to protect the information. Similarly, patients have their rights which relate to the erasure of the information, rectification, and addition of necessary information as stipulated by Chapter three section 46, 47 and 48, (Data Protection Act, 2018). On the other hand, information at times is automatically processed. The decision-making procedures are clearly set out in section 49. Clients have the right to deny the automated decision making, (Swanson et al., 2018, 542). They have to be consulted in the event that decisions are being made by medical practitioners. In a nutshell, the medical profession is governed by Code of ethics, regulations, and laws. Practitioners have the duty of respecting the patient’s requests and this can be achieved by adhering to the rules of confidentiality. On the other hand, doctors have the duty of ensuring that members of public are safe by advising their patients on the consequences of transmitting the diseases, (Fabre, 2017, 357). In such circumstances, patients have to be engaged and counselled so that they can become aware of the consequences that may be faced especially during the transmission of infectious diseases such as HIV Aids. Above all, Dr Hope must adhere to confidentiality between him and Mr. Johnson. Also, Mr. Johnson should take a step by informing his ex-wife and current girlfriend about his HIV status. References Data Protection Act 2018 Chapter 1-10 Fabre, J., 2017. Too soon to assess effects of deemed consent to organ donation in Wales. BMJ: British Medical Journal (Online), 357. O’Brien, J. W., Natarajan, M., & Shaikh, I. (2017). A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law. Annals of medicine and surgery, 18, 10-13. Papoutsi, C., Poots, A., Clements, J., Wyrko, Z., Offord, N. and Reed, J.E., 2018. Improving patient safety for older people in acute admissions: implementation of the Frailsafe checklist in 12 hospitals across the UK. Age and ageing, 47(2), pp.311-317. Paul, R., Islam, M.N., Kabir, E., Khan, H.R. and Kundu, U.K., 2017. Tumors of the eyelid-a histopathological study at tertiary care hospitals in Dhaka, Bangladesh. IMC Journal of Medical Science, 11(1), pp.5-10. St John, E. R., Scott, A. J., Irvine, T. E., Pakzad, F., Leff, D. R., & Layer, G. T. (2017). Completion of hand-written surgical consent forms is frequently suboptimal and could be improved by using electronically generated, procedure-specific forms. the surgeon, 15(4), 190-195. Swanson, D.L., Venneugues, R.V., Vicencio, S.Q., Garioch, J., Biryulina, M., Ryzhikov, G., Hamre, B., Zhao, L., Castellana, F.S., Stamnes, K. and Stamnes, J.J., 2018. Optical transfer diagnosis differentiating benign and malignant pigmented lesions in a simulated primary care practice. British Journal of Dermatology, 178(2), pp.541-546. Wong, D.J.N., Harris, S.K., Moonesinghe, S.R., Moonesinghe, S.R., Wong, D.J., Harris, S.K., Bedford, J., Boney, O., Chazapis, M., Drake, S. and Farmer, L., 2018. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals. British journal of anaesthesia, 121(4), pp.730-738.

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