Year on year doctors top the IPSOS poll for the most trusted profession. While pollsters do get it wrong sometimes (we need no reminding), on this one they are probably spot on.
Trust sits at the heart of the doctor-patient relationship – it is fundamental. I for one have discussed issues with my GP which I would never dream of discussing with friends and family, and as a doctor myself, have been at the receiving end of equally personal and confidential information from patients.
The ongoing debate around proposals for mandatory reporting of child abuse - and the NSPCC’s warning that this could deter victims from approaching professionals - has however made me stop and take stock of the current status of the doctor-patient relationship. The list of situations where a doctor must report on a patient is increasing, and while changes in mandatory reporting are well intended, I fear there is a risk they could harm the very people they aim to protect, and seriously erode the foundations of trust.
Doctors are already under a professional obligation, based on GMC guidance, to take action to protect the interests of vulnerable patients and to balance the patient’s interest against that of the public.
Mandatory reporting of Female Genital Mutilation (FGM), provisions under the Terrorism Act 2000, and pressure by the Border Agency to divulge information on patients in my view differs from the long established obligation on health professionals to notify authorities of suspected infectious diseases, so they can monitor and provide early warning of an outbreak.
The latter is clearly a public health issue, the former are societal or political issues. Is it right that doctors must now also be accountable for policing our communities?
The sensitivities and complexities are immense, and must be acknowledged - for example with child abuse or domestic violence cases the doctor needs to maintain the patient’s trust so they do not feel betrayed or unsupported during an already difficult time. Ideally the doctor would have built up the patient’s confidence in them enough to agree to information being disclosed to the relevant authorities. There will be some situations where action has to be taken immediately - with or without patient consent - but there are equally other circumstances where rushing into a disclosure could in fact leave the patient at greater risk.
FGM cases, where the mandatory duty to report suspected cases only applies to victims under 18, are of course equally difficult and come with their own particular set of challenges. Abhorrent acts like these should not be tolerated in society but should those supporting victims be under a legal obligation to inform on their patients, and to do so in a manner and timeframe dictated by statute?
Before Government considers imposing more reporting laws on doctors, it is vital it considers the wider implications. A balance must be struck between a duty to report and ensuring patients are not deterred from approaching their doctor for confidential medical advice, or seeking medical attention when they need it most.
There is also the risk that patients are reported on multiple occasions by different agencies further increasing hurt, humiliation and the likelihood of them losing trust in their doctor and withdrawing.
Thorough consideration must be given to how all of these risks can be mitigated and the role and judgement of doctors – those who are best placed to support their patients - must form a key part of the conversation.