Peter,

My thoughts would be:
1) This offence is serious enough to consider whether the medical team should breech confidentiality.
2) Confidentiality is so significant a concept that it should only be breeched in extreme circumstances - just because a serious offense has taken place you do not have to breech confidentiality.
3) We have a duty to allow our patients to make their own decisions, even if to our way of thinking they are not making good choices. We do not always have a duty to protect patients from the consequenses of their choices.

This girl needs the time that you spent in order to discuss her options. I would encourage her to speak to the police so that she can also discuss her options with them. I would try very hard to ensure that the police officer she spoke to was a specialist in sexual assault. Speaking to a sympathetic police officer does not in any way commit her to co-operating any further, but is an important part of defining her options.

If she made the choice not to proceed further, I would ask her if it was OK for me to talk to her GP (sorry to tread in an obviously sensitive area). I don't think that the circumstances justify breeching her confidentiality. I think that breeching her confidentiality might well be a 'cultural imperialism' that did not take account of the suffering that it might cause to the patient.

Tim. Coats.

PS. What a relief to be able to use the word 'breeching' in a proper context!


-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Peter Cutting
Sent: 17 June 2005 08:24
To: [log in to unmask]
Subject: Re: Rape & confidentiality


Thanks for all your thoughts.. I was particularly impressed by the GP vs ED side spat.. always good for a giggle.. and dont start me on Primary care in my area  :) 
I did indeed spend a lot of time with her...... and in the meantime the rest of the ED went belly up ( I await with eager anticipation the emails from the mangerial team asking exactly why so and so breeched when I was on the shop floor) 

Surely Rape does constitute a serious arrestable offence so you can breech confidentiality... and indeed do you not have a responsibilty to do so?
would those of you advocating not informing the police feel the same if she had acid thrown in her face, been stabbed or shot........ all serious arrestable offences too? (yes firearms are different but you get the idea)

I share this out of interest in other senior ED docs views on the real world and what they think............not out of an attempt to display prowess!
Cheers
Peter


>>> [log in to unmask] 07:59:34 17/06/2005 >>>
Sorry Jel - at risk of flying off the thread and also being accused of GP
bashing I have to agree with Adrian whole heartedly. However, on the
thread - if she refuses to go to the police then there is actually nothing
we CAN do. However what we SHOULD do is exactly what everyone else has said,
but the forensic evidence which could be gathered will be severely limited.
This lady needs help and this presentation may well be a cry for help.
However, if she refuses the help, what can we do? Detailed notes are
obligatory and she needs to be made to understand the consequences of her
refusal both in terms of destruction of forensic evidence and also in terms
of what this assailant may do in the future. She can also make a "Statment
of Fact" to the police which entails a factual statment being taken but no
further action results unless the lady wishes it. Transfer to a safe house,
if appropriate and accepted, may be an option, but we all know how pressed
these services are.

Contrary to the views expressed by our primary care colleagues below, I have
spent several hours with this type of presentation over the years and I know
that my colleagues don't just "get rid."

Forgive the rant, but I am one of that rare breed - a senior ED doc who
chose to come back into Emergency Medicine from GP land - and have recently
been very appalled by the standard of service provided by the primary care
network both locally and nationally.


Simon

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Jel Coward
Sent: 16 June 2005 23:41
To: [log in to unmask] 
Subject: Re: Rape & confidentiality


Adrian Fogarty wrote:
> You're kidding us surely... In DMG's words, you don't have the problem
> of the SHO ringing in sick on Friday afternoon and you just cannot
> close. Sorry, but GPs don't have that kind of pressure any more. When
> their slots fill up, the patients simply get diverted to A&E. That's not
> my cynical attitude playing out, that's reality in this part of the
> world. And it's not GP bashing either,

Yes you are and it belittles you.

Jel

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