Medico-legal concerns

In total, 56 files were opened at the MDU in relation to patients who were HIV positive over a five year period between 2015 and 2020. General practice made up the largest numbers of files, with 65% being from GPs and 16% being from practice managers. Genitourinary medicine specialists made up 9% of cases and the remainder were from members working in emergency medicine, general medicine, infectious diseases and occupational health.

Half of cases involved patient complaints, with one of the complaints becoming a clinical negligence claim and another escalating to a GMC investigation. The other half of cases centred on members' requests for general advice.

Confidentiality

Issues of patient confidentiality were the most common reason for a file to be opened, accounting for a third of cases (34%). The majority were either due to a complaint following a breach of confidentiality, or a request for advice about whether to inform others, who may be at risk, about a patient's HIV status.

Breaches of confidentiality are rare, but may happen due to a systems error - for example, when an email is sent to the wrong recipient or to a list of recipients. If that happens, it is important to notify those affected as quickly as possible, apologising and explaining the steps that have been taken to remedy the issue and prevent it happening again. Depending on the severity of the incident, it may also be necessary to carry out a significant event audit and to notify the Information Commissioners' Office (ICO). The MDU can advise you on the specific circumstances of any case.

As with all patients, consent should generally be sought from them before sensitive information is disclosed to others and occasionally, patients do specifically ask that others aren't informed of their medical condition. Where a patient has an infection, there may be concerns in some cases that this could be passed on to others and those at risk may need to be informed. However, it is important to note that because a patient is HIV positive it does not mean they can transmit the virus to others. Where a patient has an undetectable viral load there is no risk of transmission of the virus to someone else.

If a patient asks that their GP is not informed about their HIV status, it is important to explain to them the importance of their GP being aware, so they can take this into account when treating the patient for other conditions that may or may not be related to their HIV infection. The GP will need to be alert to any complications that could arise so they are picked up early, and what medication the patient is taking, to avoid any interactions when prescribing new medicines.

Knowing the patient is HIV positive could avoid other unnecessary investigations. If the patient understands the risks to themselves of their GP not being informed but is still adamant they don't want their GP to be informed about their HIV status, their wishes should be respected. They should be made aware that they can change their mind at any time.

If a person who is HIV positive won't tell a partner who is at risk of transmitted infection, you may inform that person if it's likely they are at risk of serious harm and the patient cannot be persuaded to inform them (see GMC guidance in Confidentiality - disclosing information about serious communicable diseases).

If another person is at risk and may need prophylactic treatment but the patient has not given permission for this information to be shared, it may be appropriate to pass on limited information to an appropriate person, in the public interest. The patient should be advised of the actions you intend to take and your justifications for doing so.

In some instances, relatives of deceased patients asked that the patient's HIV status was not recorded on a death certificate. In these cases the member involved was advised to sensitively explain to the relative that this wouldn't be possible, as if a serious communicable disease has contributed to a patient's death, the doctor must record this on the patient's death certificate.

Confidentiality concerns and complaints in HIV cases

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Confidentiality concerns and complaints in HIV cases