GP · core-skills
Consent, capacity, and confidentiality in general practice
Also known as Informed consent · Mental capacity · Patient confidentiality · Gillick competence
GP-fellowship guide to consent, capacity and confidentiality: the elements of valid informed consent, four-ability capacity assessment, Gillick competence, confidentiality exceptions including notifiable diseases and safeguarding, advance decisions and surrogate decision-makers, emergency treatment without consent doctrine, and SPIKES for delivering serious news.
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Red flags
- A patient with fluctuating confusion being asked to sign a consent form - assess capacity properly; a signature without capacity is legally void
- A 15-year-old requesting contraception without parental knowledge - Gillick competence applies; assess and respect confidentiality unless safeguarding risk overrides
- A patient with a notifiable disease refusing contact tracing - public health legislation overrides individual confidentiality
- An unconscious patient needing emergency treatment with no advance decision and no surrogate - treat under the doctrine of necessity; do not delay
Overview
Consent, capacity and confidentiality underpin every GP consultation. Getting them wrong risks legal liability, patient harm and destroyed trust. Getting them right is the foundation of ethical practice.[4]
References4ShowHide
- [1]Baile WF, Buckman R, Lenzi R, et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer Oncologist, 2000.PMID 10964998
- [2]Wheeler R Gillick or Fraser? A plea for consistency over competence in children BMJ, 2006.PMID 16601020
- [3]Malhotra C, Huynh VA, Shafiq M, et al. Advance care planning and caregiver outcomes: intervention efficacy - systematic review BMJ Support Palliat Care, 2024.PMID 35788465
- [4]Moskop JC Informed consent and refusal of treatment: challenges for emergency physicians Emerg Med Clin North Am, 2006.PMID 16877132