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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 December 15; 335(7632): 1226.
PMCID: PMC2137066
Doctors and the State

How much longer will patients trust us?

Christopher N Jones, consultant forensic psychiatrist

Before the British medical profession becomes too self-satisfied about the report that 5% of East German doctors reported confidential information to the Stasi,1 we should perhaps take a look at our own practice.

Under the Multi-Agency Public Protection Arrangements (MAPPA), all NHS bodies and, indirectly, all employed doctors, are under a statutory duty to participate in local arrangements specifically designed to “promote information sharing” between all the involved agencies—a definition wide enough to encompass police and probation, social services, housing, education, jobcentres and registered landlords. The MAPPA routinely expects disclosure of substantial amounts of information obtained in the doctor-patient relationship; in some cases this provides most or all of the information available to it. People who are understandably reluctant to reveal certain information to the police or social services may report this more freely in what they believe to be a confidential clinical setting. They may still trust us now, but for how much longer?

Working under the mission statement “Protecting communities from violent and sexual offenders”—something that might look out of place above the door of a consulting room—the MAPPA has extended substantially the longstanding practice of disclosuring clinical information to state agencies in areas such as driver licensing and public health, with little resistance from the medical profession and virtually no attempt to inform patients that the rules have changed. Perhaps we are reassured that information, once disclosed to the wide range of participating agencies, is still considered to be “confidential”: our patients are unlikely to be so sanguine, and may have another word for it.

Only 5% of East German doctors worked as “unofficial spies” for the state—we should be so lucky.


Competing interests: None declared.


1. Tuffs A. One in 20 East German doctors spied on patients or colleagues. BMJ 2007;335:1113 (1 December.) doi:10.1136/bmj.39412.492836.94 [PMC free article] [PubMed]

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