Forums » Off duty » General » What do you do next? (when you suspect a patient has committed a serious crime)
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What do you do next? (when you suspect a patient has committed a serious crime)
posted at 3/1/2013 12:38 PM GMT
on bmj.com
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Posts: 959
First: 15/7/2011 Last: 21/5/2013 |
This topic has come to life following queries in the thread of Should Doctors inform their patients that they have a criminal record?. What happens if a patient tells you that he has or is about to commit a crime, or you suspect he has committed a serious crime. For me this topic arises almost every day when Doctors seek advice about such issues. So here is a real situation, what would you do: |
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 3/1/2013 5:35 PM GMT
on bmj.com
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Posts: 526
First: 6/9/2012 Last: 22/5/2013 |
An awful situation. I hope I shall be spared sth like this, of course, but still-- a doctor should treat patients and not ask about crimes they commited. This is for the law to judge. If such a pt came to me, hypothetically, I would try to treat him according to medical standards, but without any excess of kindness, I guess. Of course, this is purely hypothetical, would certainly depend on the sort of crime he had commited, and who does really know what they would do in an emotionally charged situation like the one you described ? There is a law (in Germany) that you have to turn sb in if you get the impression he/she will be an immediate danger to sb else, like sb telling you "I ´ll go home now and kill my wife". It´s called sth like higher goods. This does not apply to crimes that have already have taken place and thus can´t be interfered with any more. Patients´confidentiality would outweigh the victim´s right here. I have treated many patients without asking too many Q about the way they got injured in the past. If it was not an emergency, you could maybe refuse to treat the man if you felt you couldn´t do it ( like you were personally involved in a similiar crime etc) and leave it to sb else. |
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 3/1/2013 6:20 PM GMT
on bmj.com
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Posts: 2049
First: 12/3/2010 Last: 22/5/2013 |
The criminal act has happened, so you cannot prevent it, and unless you suspect this man is about to do the same to the girl or another, you have no reason to break confidentiality and ring the police. But you have an opportunity to challenge his story, not using the girls 'evidence' that would implicate her and break her confidentiality. You could say that his wounds don't match the story. After all, what bouncers scratch someone's eye out? |
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 3/1/2013 7:37 PM GMT
on bmj.com
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Posts: 324
First: 23/12/2011 Last: 3/5/2013 |
I suppose there are many ways to defend any answer you give. Turning things like 'Non-maleficence' into notifying someone because in some twisted way by not stopping this guy you are potentially doing harm to someone who may become your patient. I would however be inclined to agree with JohnD. Challenge his story and see what he says. Probably one of the most complex ethical dilemmas that you may face as a doctor I think. |
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 30/1/2013 3:41 PM GMT
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Posts: 21
First: 30/1/2013 Last: 31/1/2013 |
I had not given this issue any thought at all till I saw this post - but now it's going to bug me for some time, I can tell! I suppose confidentiality above all because what if your suspicion is completely unfounded, or, more importantly, breaking confidentiality once sets a dangerous precedent for the next time. But a really really difficult decision, I admit.
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 31/1/2013 9:05 AM GMT
on bmj.com
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Posts: 959
First: 15/7/2011 Last: 21/5/2013 |
Darren thank you for bringing this scenario alive again. Just today a report on the news claims that Emergency staff are not cooperating with Police sufficiently to help solve crime and ensure offenders are being brought to justice. The duties to maintain confidentiality and to be a responsible citizen and cooperate and assist law enforcement can be difficult to reconcile. I will not give the 'solution(s)' just yet but see if anyone else has further observations to make. Bear in mind that the duty of confidentiality is very important but are there times when a Doctor MUST inform the Police?. |
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 31/1/2013 9:55 AM GMT
on bmj.com
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Posts: 134
First: 25/5/2011 Last: 17/5/2013 |
I think that I would ring the Police and suggest that they ring the Department in a few minutes, formally via the Unit Manger, to ask if we had recently treated any patients whom they would be interested in speaking to, with a tattoo on their neck and particular injuries suggested by a complainant. I would have to explain that I could not break confidentiality and lay information unbidden in my professional capacity, but that as a law-abiding citizen I would always co-operate with the forces of law and order. |
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 31/1/2013 10:11 AM GMT
on bmj.com
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Posts: 2049
First: 12/3/2010 Last: 22/5/2013 |
Yes, like any citizen you have a duty to preventa crime. If you have reasonable suspicion that someone is about to do so, you can exercise a citizen's arrest, but usually it's better and less personally risky to invoke the Police. But it's still a difficult call. Say you see your schizophrenic patient by appointment. They tell you that they have fantasies of injuring someone and ask for medication or other help. Contrast that with the same patient who sees you for advice on back pain, who you recognise has relapsed and is carrying a knife. But in other situations, we are none of us Sherlock Holmes. Despite the origins of Conan Doyle's character in his medical training under Joseph Bell, few doctors can look at a patient and say, "Ah! An accountant with a demanding wife and an expensive lover, who is about to defraud his employers." We must all, like Dr.Watson, stand agape that our patients do crime and we do not know it. John PS Adrian, And then the manager comes to you and says that the Police want to see the medical records of all your male patients between 20 and 30 years who have been treated in the last 24 hours, to see which had facial injuries and tattoes in line with the rapist's. If you consent, you have broken confidentiality on not just the actual attacker, but every one of those young men. The best intentions can have the worst outcomes. If you grass up this bag of scum, it becomes obvious to even his meagre intelligence that his attendance at your deparment gave him away. He or his friends may be waiting for you on your way home, or may make trouble and damage in your A&E. You may be brave or a judo Black Belt, but you can't treat other patients while you are in the ward after a kicking, and your department won't thank you for your misplaced public spirit. J. |
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 31/1/2013 12:32 PM GMT
on bmj.com
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Posts: 1178
First: 19/4/2010 Last: 21/5/2013 |
I did my LearnPro module on protecting at risk adults yesterday, and in Scotland, at least, the advice here would be to inform the police. A crime has occured, I have information that could lead to, for want of a better word *justice*, and could prevent a recurrence of the crime. I would call the police. If the Man U fan is innocent, it would not take him long to prove his innocence, and if he is guilty, then I've assisted in the apprehension of a criminal. We are told to tell patients and relatives that we cannot guarantee that anything they tell us is confidential - we are obliged to tell the relevant authorities if we suspect a person is at risk, and the information we are told can prevent harm to anyone.
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Re: What do you do next? (when you suspect a patient has committed a serious crime)
posted at 31/1/2013 2:04 PM GMT
on bmj.com
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Posts: 134
First: 25/5/2011 Last: 17/5/2013 |
PS Adrian, And then the manager comes to you and says that the Police want to see the medical records of all your male patients between 20 and 30 years who have been treated in the last 24 hours, to see which had facial injuries and tattoes in line with the rapist's. If you consent, you have broken confidentiality on not just the actual attacker, but every one of those young men. The best intentions can have the worst outcomes. If you grass up this bag of scum, it becomes obvious to even his meagre intelligence that his attendance at your deparment gave him away. He or his friends may be waiting for you on your way home, or may make trouble and damage in your A&E. You may be brave or a judo Black Belt, but you can't treat other patients while you are in the ward after a kicking, and your department won't thank you for your misplaced public spirit. J. Posted by John D[/QUOTE] The wonderful skills of Unit Managers include having had the time to read the Trust Policies on how to act in this situation. I don't believe that it would not have occurred to the Police to ring around AED departments of their own accord, I may have merely increased their efficacy in doing so. I have no idea about the legal side of what goes on after they request information, but I would have given them enough of a hint to save their time without breaking any confidentiality. If the Manager then ordered me to give information as you outlined, I would have to first take defence organisation advice. I seem to remember that the GMC advice is that confidentiality can be breached without consent if it is in the interest of public safety. My view of the balance here is that there is a young man out there who has attempted to rape once and having crossed this boundary may well do so again with catastrophic consequences for the victim. In the interests of public safety, if I am formally asked to breach confidentiality, then I will; but having ensured that a formal procedure has been followed and all is above board. Preventing another rape victim is a worthy cause. My appearance as a Court witness would only be to confirm that I had treated the suspect and to confirm the process and reasons that I broke confidentiality. I would regard myself as a poor specimen of my profession were I to allow myself to be intimidated into silence and thereby condone the continuation of a sexual crime spree by a deviant individual. As Edmund Burke said, "All that is necessary for the triumph of evil is that good men do nothing." |
Forums » Off duty » General » What do you do next? (when you suspect a patient has committed a serious crime)
