If you think the patient may be engaging in an activity where they pose a very real risk of danger to the public, such as the patient operating heavy machinery or driving when they are not fit to do so ²⁷⁰, but you are not sure whether you should act, ask yourself: 

1. what might the outcome be in the short- or longer-term if I do not raise my concern? 
2. how could I justify not raising the concern?

If you decide to proceed, you should:

1. first tell the patient that they are unfit to engage in the activity in question and give the reasons
2. tell the patient to tell the relevant authority
3. put your advice in writing to the patient, if appropriate
4. keep a copy of any correspondence with the patient on the patient record.

Sometimes the actions in paragraph C92 might not achieve their aim or would take too long to do so. You have a duty of confidentiality to the patient, but this is not absolute and can be broken if it is in the public interest to do so. Guidance from the Department of Health includes the example of reporting a driver who rejects medical advice not to drive as one where the public interest can be a defence to breaching patient confidentiality.²⁷¹

If you conclude that the public interest outweighs the duty of confidentiality, for example a patient who has told you that they intend to commit a crime or who continues to drive after being told not to, you should: 

1. notify the relevant authority, and, if appropriate, provide evidence of clinical findings
2. notify the patient’s GP of the action being taken
3. notify the patient if appropriate.

If you disclose confidential information about a patient you must be prepared to explain and justify that decision. If you are unsure if this is appropriate, seek advice.

In other circumstances, you should not disclose any clinical, personal or non-clinical information about a patient to a third party, even if that person says they are family or a close friend. This is because it might harm the patient if you divulge the information, for example, if the patient is a victim of abuse. This includes the patient’s: 

1. name
2. contact details
3. personal circumstances
4. any other information that might disclose the individual’s whereabouts, for example whether they have been in your practice.