What are ‘patient secrets’ in occupational health practice? Privacy and confidentiality in 'dual obligation doctor' situations.

In order to understand what might constitute a ‘patient secret’ in occupational medicine, this article first reviews why information is confidential in doctor–patient relationships in therapeutic settings. The General Medical Council does not treat medical confidentiality any differently whether the setting is therapeutic or not. However, it will be argued that the legal and ethical justifications for medical confidentiality in therapeutic situations cannot simply be transposed into the occupational medicine setting, especially in the context of independently commissioned reports. Moreover, the recent General Medical Council guidance on confidentiality, which requires doctors to seek further consent for a report commissioned by third parties, will be shown to be in conflict with English Court of Appeal judgements.