Patients as partners: dignity, fairness, communication and shared decisions

How should doctors translate dignity, fairness, communication and patient partnership into everyday clinical behaviour, and where do consent, capacity, confidentiality and equality law add further requirements?

Provides the Domain 2 professional framework and signposts the existing Consent/Mental Capacity programmes and future Confidentiality course for deeper legal mechanics.

• Treat patients as individuals and avoid assumptions about priorities or outcomes.
• Recognise dignity, privacy, fairness and the right to seek a second opinion.
• Provide understandable, accessible information and check understanding.
• Recognise when consent/capacity law or detailed GMC decision-making guidance must be followed.
• Identify how personal views or conscientious objection must be managed without unfairly obstructing care.

Patients should be treated as individuals with dignity, privacy, kindness and respect. Professional partnership requires listening to what matters to the person and not assuming which outcomes they value.

Fair treatment is not identical treatment. Communication support and reasonable adjustments may be necessary to give a person an equitable opportunity to understand, participate and access care.

Patients have the right to accept or refuse advice when they have the relevant decision-making ability. Doctors should explain why they recommend an option and why an option is not offered rather than using authority to close discussion.

Information should include the condition/prognosis where relevant, options including no action, benefits, harms, uncertainties and likelihoods, tailored to what the patient wants or needs to know. The detailed consent course carries the Montgomery/McCulloch treatment.

Communication difficulty, disability, sensory impairment, language difference or neurodivergence should prompt support, not assumptions about capacity. Capacity is decision- and time-specific under the applicable national law.

Confidentiality should be integrated into ordinary communication: who is present, what information is shared, whether the patient agrees, whether a legal/public-interest basis exists, and how much information is necessary.

Personal beliefs may be held and, in defined circumstances, may affect what a clinician personally provides, but they must not be imposed on patients or become a barrier to appropriate access. Current GMC personal-beliefs guidance is under review, making this an update-sensitive area.

Equality law overlaps with professional fairness. In Great Britain the Equality Act 2010 is central; Northern Ireland has separate equality statutes. The professional duty not to discriminate applies UK-wide through GMC standards regardless of the statutory route.

1. Start with the individual patient: what matters to them, what support do they need and what assumptions might be operating?
2. Provide accessible information about relevant options, uncertainty, benefits, harms and no-action where appropriate.
3. Check understanding and decision-making ability without confusing communication difficulty with incapacity.
4. Respect privacy and confidentiality; establish who may receive information and on what basis.
5. Identify whether consent, capacity, equality or personal-belief guidance adds a specific legal/professional requirement.
6. Agree and document a plan that preserves fair access and patient partnership.

Scenario 1. A deaf patient is offered written notes instead of a professional interpreter for a complex high-risk decision.

Reasoning prompt: identify immediate risk; identify the professional source; check any separate legal/local framework; act, communicate, document and escalate proportionately.

Scenario 2. A patient declines a recommended intervention after understanding the risks; staff call the decision “non-compliant”.

Reasoning prompt: identify immediate risk; identify the professional source; check any separate legal/local framework; act, communicate, document and escalate proportionately.

Scenario 3. A doctor’s conscientious objection creates a delay in access to a lawful service.

Reasoning prompt: identify immediate risk; identify the professional source; check any separate legal/local framework; act, communicate, document and escalate proportionately.

• Treating everyone the same is always fair.
• A patient who refuses advice lacks capacity.
• Family members are entitled to confidential information because they are next of kin.
• Consent is the signed form.
• Personal beliefs automatically justify refusal of involvement.

• Have I asked what matters to the patient rather than assumed?
• Is information accessible and tailored?
• Have I distinguished communication support from capacity?
• Are reasonable adjustments needed?
• Is confidentiality respected with family/carers?
• Could my personal views create a barrier to care?

Optional reflection

Do not enter identifiable patient, colleague or employer information.

• Where might an assumption about age, disability, culture or lifestyle alter the options you discuss?
• What adjustment could make a common consultation more equitable?

• Dignity and privacy are explicit professional duties.
• Fairness may require reasonable adjustments.
• Patients can refuse recommended care if validly deciding.
• Information should be tailored to the individual.
• Communication barriers are not incapacity.
• Confidentiality applies after death as well as during life.
• Personal beliefs must not be imposed on patients.
• GMC fairness is UK-wide; equality statutes differ by nation.
• Material-risk law and professional dialogue overlap but are not identical.
• No-action/no-treatment may be a relevant option to discuss.

These sources underpin the module. Check current versions for time-sensitive decisions.

• GMC-04 - General Medical Council / Domain 2: Patients, partnership and communicationOpen official sourceUK / Professional standards. Dignity; fairness; consent; information; candour; complaints
• GMC-13 - General Medical Council / Confidentiality: good practice in handling patient informationOpen official sourceUK / More detailed guidance. Ethical and legal confidentiality framework
• GMC-15 - General Medical Council / Personal beliefs and medical practiceOpen official sourceUK / More detailed guidance. Beliefs, conscientious objection and patient access
• LAW-03 - UK Parliament / Equality Act 2010Open official sourceGreat Britain / Primary legislation. Equality/discrimination/reasonable adjustments; does not apply in NI
• POL-07 - Equality Commission for Northern Ireland / Equality laws in Northern IrelandOpen official sourceNorthern Ireland / Official equality guidance. NI has separate equality/discrimination laws; Equality Act 2010 does not apply
• CASE-01 - UK Supreme Court / Montgomery v Lanarkshire Health Board [2015] UKSC 11Open official sourceUK legal significance / Judgment. Material risk and reasonable alternatives in consent
• CASE-02 - UK Supreme Court / McCulloch v Forth Valley Health Board [2023] UKSC 26Open official sourceUK legal significance / Judgment. Reasonable treatment alternatives and clinical judgment