SJT Textbook: Confidentiality — Disclosing Information for Employment, Insurance & Similar Purposes

GMC Disclosure for Employment and Insurance – MSRA SJT Overview

GMC disclosure for employment and insurance is a core confidentiality topic tested repeatedly in the MSRA Situational Judgement Test.

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🎯 THE CORE PRINCIPLE

Doctors often receive requests for patient information from employers, insurers, benefit agencies, or other third parties. These requests create dual obligations: a duty of confidentiality to the patient and a duty of accuracy, honesty, and fairness to the third party.

In the MSRA SJT, high-scoring responses show you understand that patient consent, relevance, accuracy, and minimum necessary disclosure are fundamental. You must not release full medical records unless legally required. Reports must be factual, balanced, and free from speculation. Patients should usually be offered the chance to review what will be released.

Exceptions apply where the law compels disclosure (e.g. court orders) or where serious harm/public interest overrides confidentiality.

🧩 KEY PRINCIPLES (MSRA SJT Interpretation)

1. Always obtain informed, explicit consent for disclosure

Core idea: You must have clear permission before accessing, examining, or sharing identifiable information with third parties. What the SJT tests:

* Checking that consent is informed and specific
* Explaining purpose, recipients, and scope
* Respecting patient refusal High-yield:
* Consent is the default requirement unless law/public interest applies.

2. Disclose only relevant and proportionate information

Core idea: Provide the minimum necessary details — not full records. Exam cues:

* Share only what directly answers the request
* Avoid extraneous or historical details
* Redact unrelated information Red flags:
* Sending entire medical records
* Oversharing because “the employer asked for everything”

3. Maintain impartiality and accuracy in reports

Core idea: Your duty is to be truthful, objective, and evidence-based. What the SJT tests:

* Avoiding speculation or bias
* Ensuring factual accuracy
* Clearly separating opinion from evidence High-yield:
* “Provide a balanced, unbiased report” is nearly always correct.
* “Confirm factual accuracy before disclosure” scores highly.

4. Offer patients an opportunity to review reports

Core idea: Patients should usually have the chance to see reports before they are released. Exam cues:

* Let the patient review unless law prevents delay
* Correct factual errors if identified
* Record the decision and discussion High-yield:
* “Offer a copy of the report” or “offer review” is often high scoring.

5. Understand dual obligations to patients and third parties

Core idea: You owe confidentiality to the patient AND accuracy to the organisation requesting information. Exam cues:

* Keep boundaries clear
* Avoid breaching confidentiality
* Avoid misleading third parties Red flags:
* Prioritising the employer’s needs over confidentiality
* Concealing relevant information at the patient’s request (unless harmful)

6. Know the exceptions: legal and public interest disclosures

Core idea: Some disclosures must occur even without consent. Legal requirement examples:

* Court orders
* Statutory reporting (e.g. notifiable diseases, certain benefit assessments) Public interest examples:
* Risk of serious harm to others High-yield:
* If disclosure is *legally required*, the doctor must comply — but share minimally and inform the patient where appropriate.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Seek explicit, informed patient consent before disclosure.
2. Explain who will receive the information and why.
3. Limit information to relevant, necessary, factual details only.
4. Provide balanced, accurate reports without speculation.
5. Offer the patient a copy or review unless legally restricted.
6. Document the consent discussion and content of the report.
7. Decline to provide whole records unless legally mandated.
8. Follow statutory reporting requirements and court orders.
9. Disclose in the public interest when serious harm is likely.
10. Seek advice if dual obligations create uncertainty.

These traps involve oversharing, dishonesty, or ignoring legal obligations.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I will limit the information to what is relevant and necessary.”
* “I will provide an accurate, balanced report.”
* “I will offer the patient an opportunity to review the report.”
* “I will comply with legal requirements while respecting confidentiality.”
* “I will document the rationale and consent clearly.”

R – Relevant information only
E – Explicit consent
P – Proportionate disclosure
O – Offer patient review
R – Record decisions clearly
T – Truthful, accurate reporting
S – Statutory/legal duties override consent
A – Avoid oversharing
F – Fair and balanced opinion
E – Explain purpose and scope

📋 QUICK FAQ

Do employers and insurers always require full medical records?
No — doctors should only disclose relevant, necessary information. Do I need explicit patient consent?
Yes for most disclosures, unless required by law or justified by public interest. Should a patient be allowed to review a report?
Usually yes, except where law prevents delay. Can I omit relevant information to help the patient?
No — reports must be truthful, accurate, and fair. When can confidentiality be overridden?
When legally mandated or required to prevent serious harm.

📚 GMC ANCHOR POINTS

* Confidentiality (third-party disclosure section)
* Minimum necessary disclosure
* Duty of accuracy and impartiality
* Explicit consent requirement
* Legal and statutory duties
* Public interest exceptions
* Documentation and transparency

💡 MINI PRACTICE SCENARIO

A patient asks you to write a medical report for their employer about fitness for work but insists you omit their recent hospital admission for alcohol withdrawal. Best action: Explain that you must provide an accurate, honest report and cannot omit relevant information. Seek explicit consent; if denied, decline to write the report. Why: You must balance confidentiality with your duty of accuracy and honesty.

🎯 KEY TAKEAWAYS

✓ Consent is essential for disclosure.
✓ Share only relevant, necessary, factual information.
✓ Reports must be accurate, impartial, and evidence-based.
✓ Patients should usually be offered the chance to review reports.
✓ Legal duties and public interest may override consent.
✓ Never overshare, speculate, or alter records.
✓ Document everything.

🔗 RELATED TOPICS

* → Confidentiality: Disclosing information without consent
* → Data protection law (GDPR/DPA)
* → Medical reports and legal processes
* → Duty of candour
* → Acting as a witness in legal proceedings
* → Professional boundaries

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

An employer requests a detailed medical report about a patient. The patient agrees but asks you not to mention a recent diagnosis of severe depression.

Options:
A. Explain you must provide an accurate, honest report
B. Omit the diagnosis as requested
C. Decline to write the report if the patient withdraws consent
D. Provide only relevant information in the report
E. Allow the employer to access full medical records
F. Offer the patient a copy of the report
G. Document the consent discussion
H. Include unsubstantiated concerns to provide context

Example SJT — Rank 5 (best → worst)

You are asked to provide medical information for an insurance claim. The patient cannot be reached to give consent.

Options:
A. Decline to disclose until consent is obtained
B. Provide anonymised information
C. Disclose full information as insurers usually require it
D. Disclose only if legally required
E. Send partial information to speed up the process