It’s a busy Thursday morning. Jennifer Defoe, aged 37, approaches you. You have come to know her a little since she is keen on herbal remedies and sometimes asks your advice. Today she requests a private consultation. You are a happy to offer it.
Once she has sat down and the door is shut, she looks directly at you.
'Thank you for your time. I have an awkward request. My husband has been acting strangely recently. Yesterday I interrupted him while he was taking a capsule of some kind. He had a box in his hand but he hid it. I think it said something like Doxy or Docyc …. but I’m not sure. I don’t know what it is. I think he got it from you because there was one of your medicines bags in the rubbish bin outside and I know I haven’t bought anything from you this week.”
Jennifer takes a deep breath.
“Obviously I’ve googled it and maybe I am too suspicious, but I think it may be a treatment for an STI. If it is then why did he need it? I mean I suppose it’s obvious … I just can’t process it…… so I’m asking you please to tell me what it is because I need to know. What did you dispense to him?”
She speaks assertively.
“I need to know and I need to know now….. I have a right to know. It affects me. I’m your patient too.”
You are unsure what to do. You ask Jennifer to give you a moment to think.
You run through your options, rather anxiously since it is by no means obvious what to do. You know that you recently dispensed a 7-day supply of 100mg doxycycline capsules to Jennifer’s husband. (https://bnf.nice.org.uk/drugs/doxycycline/)
Doxycycline is an antibiotic that's used to treat infections including:
https://www.nhs.uk/medicines/doxycycline/about-doxycycline/
According to the general principle of confidentiality you are not permitted to breach the husband’s privacy. One option open to you is simply to say this to Jennifer and suggest that she asks him directly if he is taking tablets, and if he is, why.
You know that this drug is commonly prescribed for STIs but it has other uses as well, for example for severe toothache or urinary tract infection (UTI).
Since she mentioned what she suspects, and since the husband was behaving strangely, another option you have is simply to say that it is an antibiotic.
If the drug is for chlamydia, which seems possible, then this puts Jennifer at risk too, if she has sex with her husband:
“Although chlamydia does not usually cause any symptoms and can normally be treated with a short course of antibiotics, it can be serious if it's not treated early on.
If left untreated, the infection can spread to other parts of your body and lead to long-term health problems, especially in women.
In women, untreated chlamydia can cause pelvic inflammatory disease (PID), ectopic pregnancy and infertility.” https://www.nhs.uk/conditions/chlamydia/
If you don’t reveal at least some information, and the husband is lying, then you may be failing in your duty to protect her.
As cited above, there are conflicting duties, as is often the case in pharmacy practice. Which duty is primary? Again, what are the ‘vital interests of the person receiving treatment’? What is ‘appropriate’ and who is best placed to decide this?
In this instance the husband is the person receiving treatment. Does he have ‘vital interests’ or just ‘interests’? And does it make any difference? Is disclosure ‘appropriate’? Is there a ‘public interest’ consideration?
The GPhC states:
“8.2. A pharmacy professional may disclose confidential information when they consider it to be in the public interest to do so, for example if the information is required to prevent:
- a serious crime
- serious harm to a person receiving care
or to a third party, or
Which person should be at the centre of care in this situation?
In this example, after contemplation, you choose to say that you have a professional duty to maintain confidentiality, but at the same time you hand Jennifer some materials on sexual health, and the risks of transmission. She grabs them from you then stumbles to the door and leaves.
You close the door after her and sit wondering if you have done the right thing.