Confidentiality, information governance and equality

Why this matters on day one

Most breaches are mundane — a corridor conversation, a WhatsApp photograph, a screen left open, looking up a patient you know. The rules are not obscure, and the consequences are professional.

The sequence

1. 1The default. Information given in confidence stays confidential, including after death. Share on a need-to-know basis within the direct care team.
2. 2When you MAY share without consent. Where required by law; where there is an overriding public interest — risk of serious harm to the patient or others; for safeguarding. Share the minimum necessary, and document your reasoning.
3. 3When you MUST share. Statutory notifiable diseases; certain court orders; some firearms and terrorism duties; female genital mutilation in an under-18. Know that these exist and check rather than guess.
4. 4Everyday governance. No clinical photographs on a personal phone. No patient identifiers in messaging apps. Lock the screen. Do not access records of people you are not caring for — including yourself, colleagues, family and anyone in the news. Access is audited.
5. 5Equality in practice. Use interpreters rather than family members for consultations. Ask for and use correct names and pronouns. Make reasonable adjustments for disability. Do not let assumptions about age, weight, ethnicity or background shape the differential — diagnostic overshadowing is a documented and recurring source of harm.

What goes wrong

• Discussing patients in lifts, corridors and canteens.
• Clinical photographs on a personal device.
• Looking up a record out of curiosity.
• Using a family member as an interpreter for anything sensitive.
• Telling a relative details on the phone without confirming identity or the patient's wishes.