You have been treating a young male patient with a history
of depression and addiction to opioids. On previous occasions he has reported verbally
abusing his mother. About six months ago, he admitted that his mother kicked
him out of the house due to his violent outbursts*.
In a recent session, he tells you that his mother has relented
and let him back into the house. The session is about to end when he admits that
he repeatedly hit his mother a few days ago. He says he regularly feels anger
welling up inside him and indicated that he is scared he might really hurt her.
The patient did not turn up to his scheduled subsequent appointment and you
have been unable to contact him despite repeated attempts.
You are very concerned that he poses a serious risk of harm
to his mother, but you wonder where your obligation lies – is your duty to maintain
your patient’s privacy or to protect the mother’s safety by informing the
What does the law say?
health information of patients is not absolute. Circumstances may arise where
it is necessary to balance maintaining privacy of health information against
avoiding danger or harm to the community or individuals in the community.
Australian Privacy Principles, health information can only be used and disclosed where
there is consent or for a reasonable secondary purpose, including when there is
a serious threat to the life, health or safety of the patient or someone else,
or the public. Download our ‘Privacy
Essentials’ factsheet for more information.
to the Commonwealth's privacy legalisation, some states and territories have
their own legislation governing privacy obligations with which doctors must
also comply. Whilst there are some
differences in the wording used, these provisions are similar to the
What should you do in this scenario?
In the scenario above, given your serious concerns and the
patient’s failure to re-engage with treatment, you can notify the police on the
basis that he has admitted to beating his mother and there is a serious and
imminent threat to his mother’s life, health or safety. The patient may also
pose the same risk to himself or others.
had re-attended, you may consider telling the patient that you have informed
the police of your belief that he may pose a serious risk of harm. If this is
disclosed, it is essential to document any discussion in the patient’s clinical
should also document the communications with the police in the patient’s
medical record. In making the disclosure, it is important to only disclose
information as reasonable necessary for reporting the matter and not the
patient’s complete clinical records. The patient may file a breach of privacy
complaint, so your contemporaneous documentation will be important in
responding to any such complaint.
In weighing up whether to call the police, it’s also
important to bear in mind that the patient initially came to you seeking help
and it is in his best interests to remain engaged with treatment so you may
need to refer the patient to another psychiatrist.
It is inherently difficult to make these sorts of decisions
and will turn on the circumstances of each situation. As there is no mandatory
obligation to make a report in relation to a patient (except, for example,
where a child is at risk of harm), the decision will involve balancing the
patient’s confidentiality against assessing the risk of harm to themselves or
If the patient’s consent hasn’t been received,
information should only be provided to the police in these types of situations:
- a warrant or subpoena is provided (Read Chapter 1 of our handbook on
responding to requests for medical records), or
- it is authorised by a specific
legislation provision (for example, mandatory reporting of child abuse),
- there is a reasonable belief that there is a
serious threat to the life, health or safety of the patient and/or public.
*This scenario has been created based on our cumulative
experience of a number of similar cases.
If you are
faced with as similar dilemma it is unwise to make a decision to maintain
privacy, or to provide information to an appropriate authority, without first
obtaining advice. Visit
or email email@example.com, or if you require immediate
advice, call 1800 128 268.
You may also be
interested in our articles:
Patient safety and privacy: where do you
draw the line? highlights
a member case to clarify when exceptions to protect the health and safety of
your patient or someone else, apply.
Are you ready? Mandatory data breach
notification looks at what doctors and practices need to do
in the wake of new laws which have made notification of serious data breaches
Share your view
We welcome your feedback on this article – email the Editor at: firstname.lastname@example.org