After this the consultation got a bit difficult. Peter didn’t like my suggestion that he should inform all his sexual partners, including his wife. He also had a duty, for the moment, to refrain from continuing to expose others to risk. He was very clear about refusing to agree to this and his wish to maintain his right to confidentiality.
My initial thoughts were that Peter’s decision about his right to confidentiality must be respected unless there was an overriding interest in disclosing that information without his consent.
I considered this at length; I spoke with my GP partners (maintaining confidentiality), sought guidance from my defence organisation and consulted the GMC’s Good Medical Practice 2013.
While it is clear that confidentiality is the cornerstone of good care, there is a greater public interest to make a disclosure, without consent, where in doing so protects individuals or the wider public from risks of serious harm. This would apply to situations involving serious communicable disease or serious crime.
The guidance also warns that I might be called to justify my actions. Cue making good, clear contemporaneous notes.
I was sure that in the first instance I needed to take all steps necessary to persuade Peter.
I invited Peter back for a consultation, but I was unable to contact him via his mobile phone. I wrote to him with an appointment, but he didn’t attend.
I wrote, recorded delivery, again to Peter informing him of my failed attempts to contact him and explaining my intended course of action to disclose the information regarding his HIV positive status and would be offering to counsel his wife with regard to protection. I offered a further consultation and remained hopeful he would keep the appointment.
Peter was not forthcoming, and I was pretty sure his wife remained ignorant. I knew what I had to do, in the knowledge the effect this would have on his relationship and potentially to his occupation.
In the final analysis I didn’t have to do anything. The next day Peter’s wife came to see me in floods of tears, revealing what he had told her about his health and that he was off to tell his employers……..