Patient consent and confidentiality
BMJ’s policy is based on the UK’s data protection law and the English common law of confidentiality. UK authors should be aware that the General Medical Council has extensive guidance on patient consent and confidentiality and that our policy is in line with GMC advice.
- Any article that contains personal medical information about an identifiable living individual requires the patient’s explicit consent before we can publish it. We will need the patient to sign our consent form, which requires the patient to have read the article. If the patient has not seen a final version of the manuscript to be submitted to BMJ, the form must be amended to make clear what the patient has seen and that they have agreed to publication without having seen the final version of the manuscript. The consent form is available in multiple languages and the author must ensure that the form is in a language that the patient understands.
- If consent cannot be obtained because the patient cannot be traced, then publication will be possible only if the information can be sufficiently anonymised*. Anonymisation means that neither the patient nor anyone else could identify the patient. A consequence of any anonymisation is likely to be the loss of information/evidence. If this happens we will include the following note at the end of the paper: “Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.” Such anonymisation might, at an extreme, involve making the authors of the article anonymous.
*This does not apply for BMJ Case Reports which requires a signed patient consent form for every case report submitted about a living individual, without exception.
- If the patient is dead the UK data protection law does not apply, but the authors should seek permission from a relative (as a matter of courtesy and medical ethics). If the relatives are not contactable we will balance the worthwhileness of the case, the likelihood of identification, and the likelihood of causing offence if identified in making a decision on whether we should publish without a relative’s consent. For BMJ Case Reports, a document must be submitted confirming that exhaustive attempts have been made to contact the family and that the paper has been sufficiently anonymised not to cause harm to the patient’s family.
- Children – Parents or guardians can consent on their behalf but children aged between 7 and 18 must also sign the consent form in addition to the parent or guardian. For younger children, even if parents consent, authors should consider whether the child, when older, might regret publication of his or her identifiable details.
- Patients who lack capacity – If the patient lacks the mental capacity to make a decision about publication our advice is that usually no one can give consent on behalf of the patient. Even if someone has this power, by means, for example of a health and welfare power of attorney, it has to be exercised in the best interests of the patient. There may be some benefit to the patient in having his or her case described in a publication, but usually this is not obvious or certain. In such cases we will normally require any personal information to be anonymised or will not be able to publish it.
Images of Patients
Our policy on obtaining consent for publication of pictures or videos of patients is a subset of our general policy on patient confidentiality. If there is any chance that a patient may be identified from a photograph or other static or moving image, or from its legend or accompanying text, we need the patient’s written consent to publication by BMJ.
- Images – such as x rays, laparoscopic images, ultrasound images, pathology slides, or images of undistinctive parts of the body – or multimedia files (e.g. video, audio) may be used without consent so long as they are anonymised by the removal of any identifying marks and are not accompanied by text that could reveal the patient’s identity through clinical or personal detail.
- An exception to this policy of needing consent for recognisable photographs of individuals is when we use photographs from picture agencies to illustrate news stories and other articles. We state where these photographs have come from and we rely on the fact that the agencies and their photographers have obtained the relevant permissions from the people shown in the photographs. If we doubt that someone photographed could have given consent – owing for example to severe mental illness or learning disability – we will use our discretion and avoid using such images.
Patient consent form
Please use our consent form for any image, multimedia file or description that needs consent to publication.
Please print out the form, fill in the details, ask the patient or next of kin to read and sign the form, sign it yourself and submit it with the File Designation “Supplementary file for Editors only”. Please note we do not accept forms that are electronically signed.