While working a night shift in A&E last New Year’s Eve, I looked after a 17-year-old stab wound victim, Ben*. It had been a busy night, our usual winter pressures exacerbated by the flurry of drunken injuries and cocaine-induced panic attacks. Ben had been booked in by our reception team as a “wrist injury” and had been sitting in the waiting room for a long time before I saw him. He followed me into a cubicle, cradling his wrist in a tea towel under his T-shirt.
Based on his booking information I was expecting a sprain, a quick consultation, an x-ray, and then to give him painkillers to take away. Instead he unwrapped his arm to show me a 10cm gash from his wrist up his forearm. It was thankfully not too deep and I was able to stop the bleeding with a few stitches and a pressure dressing. He responded vaguely to my questions that it had been “a friend” at a party and was “no big deal”.
I asked him if he wanted me to call the police . He did not, and threatened to leave A&E with his wound still bleeding if I did. He did give me permission to fill in safeguarding paperwork and to contact his brother, who came to collect him. I explained that I would have to inform the police that the incident had taken place, but as per his wishes would not disclose any of his personal details.
My encounter with Ben was not an isolated incident. London A&E departments are encountering ever higher rates of knife crime, with one central London hospital treating 478 victims from August 2016 to July 2017, up from 172 in 2010-2011. This spate of violent crime increases demand on an already overstretched service.
Now, proposed Home Office legislation which places a legal duty on doctors, nurses and teachers to report knife crime to the police calls my management of Ben and other victims into question. In the public sector, we do not have the funding or manpower to shoulder responsibility for prevention of knife crime. I am equally concerned about the impact this new legislation could have on the victims who are seeking our care.
As doctors, we already have clear professional guidance on these issues. The General Medical Council published a guideline that we have a professional duty to report all knife and gunshot wounds to the police, but are not obliged to give up patient details or grant police access to our patients. This guidance takes into consideration our duty of confidentiality to our patients, as well as our duty to protect public interests. It allows doctors to balance these two professional principals to try and do what is best for each patient, without endangering the public.
The new proposal worries me as it disempowers healthcare professionals in their duty as patient advocates. Every day I see young people in need of medical help, who confide in me and my colleagues because of a shared understanding of their right to confidentiality. This might be a 15-year-old who asks me not to tell her mum I’m prescribing her the pill, or a 17-year-old who has presented with anxiety after smoking his first joint, begging me not to turn him over to the police. It is a privilege that these young people seek our help, and it is fundamental to the doctor-patient relationship that their autonomy is valued and confidentiality upheld.
The reality is that this new legislation will have little impact on the practice of A&E doctors. We will continue to report episodes of knife and gun crime to the police, and to advocate for our patients while remaining aware of our wider duty to protect public health.
But my concern is that it may deter young people from seeking my help. By making this a legal requirement, our promise of confidentiality is compromised. The legislation has been widely publicised in the media and I am unsure whether Ben would have sought my help on New Year’s Eve if he knew that, in doing so, he might expose himself to legal ramifications. By mandating that doctors and nurses report knife crime, we risk losing the trust of young people, discouraging them from seeking treatment, and endangering those whom the legislation is trying to protect.
*name has been changed
If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com
