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Ethical implications of consent and confidentiality
  1. Y Khan1,
  2. R J Stirling2
  1. 1SHO Ophthalmology, Ashford Hospital, London Road, Middlesex, TW15 3AA, UK; yasir1399{at}
  2. 2Darlington Memorial Hospital, Hollyhurst Road, Darlington, DL3 6HX, UK

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    Recently a prospective, observational clinical study was carried out in the department of ophthalmology, at a district general hospital. The main purpose of the study was to evaluate the medicolegal and ethical implication of consent and confidentiality in ophthalmic practice, in accordance with the guidelines provided by medical law.

    One hundred patients, who had been referred by optometrists to ophthalmologists, were included in the study. The general ophthalmic services (GOS) 18 form, a referral form used by optometrists for referring patients to ophthalmologists, which allows optometrists to share a patient's medical information with ophthalmologists, was used as a study tool to evaluate the percentage of patients giving signatory consent.

    Data was also collected regarding patients' awareness about the medicolegal implications of consent and their views about their medical information being shared among different health care professionals in ophthalmic practice.

    The results of our study show that only 15% of GOS 18 forms contained written consent by the patients for information to be shared by their optometrist. The remaining 85% were referred without obtaining an express written consent.

    These results were further supported by the information generated from a questionnaire filled in by patients attending the eye clinics. The questionnaire includes the following three simple questions: responses are alongside.

    Are you aware about the fact that you should be consented by your optometrist on the referral form? Yes/No (46% / 54%)

    Did your optometrist explain to you about the consent statement mentioned on the GOS 18 form? Yes/No (40% / 60%)

    Would you like the ophthalmologist to make available your medical information to your optometrist/ophthalmic medical practitioner? Yes/No (85% / 15%)


    Only a few GOS 18 forms contained patients' written consent for information to be sent back to the referring optometrist.

    Fifteen per cent of the patients surveyed, said they did not wish information to be shared with their optometrists. Therefore we should be careful about sending back information to optometrists where signatory consent has not been given.

    Optometrists need to be aware of this potential issue. In the light of the increasingly close relationship between optometrists and ophthalmologists (especially where they share care for glaucoma and postoperative cataract patients) it is important for the optometrist that consent is given if feedback is required.


    A good doctor-patient relationship can be defined by the three Cs: (i) Confidentiality, (ii) Consent, and (iii) Competence. If any of these three components are missing the doctor-patient relationship could be damaged and the flow of communication in both directions inhibited.

    A promise on the part of the doctor to maintain patient confidentiality is central if patients are to be allowed to speak freely. If information is shared without the patient's consent then the faith of the patient in the doctor may be forfeited.

    Consent is an integral part of the GOS 18 referral form but our study shows that it is taken for granted and is not handled in accordance with guidelines set out in medical law.

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