Confidentiality request from a worker with a positive skin check
A 52-year-old maintenance technician attends for statutory skin surveillance because he works with metalworking fluids and has had two previous excisions of basal cell carcinoma. Today you note a new, irregular pigmented lesion on his forearm that he has not noticed. He is anxious and explicitly asks you not to tell anyone at work, including his line manager, because he fears being moved off his job. He is willing to see his GP. Separately, his line manager telephones you the same afternoon asking whether the technician is 'clear' because they are planning to assign him to a new machine.
1. How do you respond to the worker's request for confidentiality, and what do you do about the lesion?
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Confidentiality is the default, and his request can largely be respected while still acting on the clinical finding.
- Clinical action: the lesion needs urgent assessment. I would explain clearly why it matters, advise him to see his GP promptly, and give him written information about what to say. I would document the finding, the advice, and his agreement to seek review.
- Consent and confidentiality: I would not disclose the clinical detail to the employer without his consent. I would explain the limits of confidentiality (risk to others, legal obligations) and confirm that this finding does not currently fall within them.
- If he declines to act: I would explain the risk of delay, offer to facilitate the GP referral, and document the discussion. I would seek consent to share limited information if needed later.
- Follow-up: arrange to review whether he attended, and record the outcome in the confidential health record.
2. How do you answer the line manager's question about whether he is 'clear'?
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The manager is asking for a fitness-for-task opinion, not a diagnosis, and I answer only in those terms and only with consent where personal information is involved.
- Without consent: I can confirm attendance and that the surveillance process is being followed, but I do not disclose the lesion or any clinical detail. I would say I cannot discuss individual health information.
- Fitness opinion: if the worker consents, I can give a task-focused opinion (e.g. fit for the new machine, with any restrictions), without revealing the diagnosis.
- Correcting the question: 'clear' is not a useful concept. I would reframe: the purpose of surveillance is to detect problems early and manage fitness, not to certify a person as disease-free.
- Practical step: explain to the manager that I will follow up with the worker and provide a fitness opinion if and when appropriate, and that the worker's GP is the right route for clinical care.
- Record keeping: document the call, what was and was not disclosed, and the basis (consent or not).