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You are a foundation doctor on your GP attachment. You are in consultation with a 35-year-old woman who has been trying for children for two years with her husband. Her husband has children from a previous marriage and she believes the infertility problems lie with her. She would like to be referred for fertility investigations.
You are aware that her husband has had a vasectomy, but he has not told her.
Choose the 3 most appropriate actions:
Advise the husband that without disclosure you will inform his wife
Phone the husband and tell him to tell his wife about the vasectomy
Refer her for investigations
Relay to her that any referral would necessitate discussion with her partner and semen analysis beforehand
Send a letter to the husband telling him to tell his wife about the vasectomy
Suggest that her husband attends with her to discuss infertility investigations
Tell the woman that her husband has had a vasectomy
Try and encourage an open discussion with them both in a consultation
Key Learning Point
You must not disclose a patient's medical information to their spouse without their express consent
This scenario relates to patient confidentiality - both that of the patient in front of you and of your other patients (in this case, the patient's husband). The best outcome would be for the husband to voluntarily disclose this information to his wife and your answers must reflect your attempts to encourage this (6,8).
You must not disclose their partner's medical information to either the wife or the husband without their express consent (1,7) and forcing the husband to disclose this information is also inappropriate (2,5). Lastly, as you suspect that the couple's fertility is likely due to the husband, it would be inappropriate to refer the wife for investigations that are both costly and invasive and thus unlikely in her best interests without clarifying the husband's aspermia first and an attempt at facilitating discussion around that (4).