The World Health Organization says interpersonal violence kills more than 600,000 and causes more than 17 million serious injuries a year.  A controversial program in the United Kingdom has doctors and hospitals reporting injuries resulting from violent crimes to the police which patients commit violence.  Some are calling it a violation of patient confidentiality.

It's a community violence prevention program that took 3 years to develop and was implemented in Cardiff, Wales back in 2001 and tried in the rest of the UK, Scandinavia and elsewhere.   Hospital ERs see a large percentage of the perpetrators and victims of violent crimes.  But, only a quarter to a third of violent incidents that end up being treated in the ER appear in police records.  Some of the reasons for under-reporting include relying on crime victims to file reports, fear of reprisals, not being able identify the assailants, and unwillingness of crime victims to have their own conduct scrutinized by police.  So, the idea behind the program is to increase crime detection by increasing the percentage of violent incidents treated in the ER that are known to the police.

In Cardiff, where it all began, a partnership was formed between police, local government, the ER, and other hospital medical personnel likely to see patients who are victims of violent crime (for example, an oral surgeon who sees lots of people who are punched or kicked in the face).  Under the program, for all patients who report to doctors with injuries from a violent incident, the location where the incident took place (including the name of the bar or night club), date and time of day, and type of weapon used in the attack are gathered electronically, analyzed and shared on a monthly basis with local law enforcement.  The data is used along with police intelligence gathering to generate maps of violence hotspots - with violent incidents being categorized as domestic, by acquaintance or by a stranger.  The maps are used to develop specific, targeted crime prevention strategies. 

In Cardiff, crime detection went up.  According to a study published on June 16 in the British Medical Journal, average rates of injuries due to violence rose from 54 to 82 per month per 100,000 population.  As detection of violent crime went up, the consequences of violent incidents rates definitely went down.  Rates of admission to hospital related to violent incidents fell from seven per month per 100,000 population to just five per month per 100,000.

In general, all health professionals are bound by professional ethics not to violate patient confidentiality.  This type of program gets around the confidentiality issue by stripping the health record of all personal identifiers  including the patient's name, date of birth, hospital record number, health card number, home address, place of employment and date of birth.  Keep in mind that there's nothing to stop legislators from passing bills that oblige health professionals to report crimes to authorities.  For instance, Ontario has a law on the books that compels health care professionals to report patients who have gunshot wounds.  Many such laws violate patient confidentiality.  In the case of the Ontario law, the provincial government decided that reporting gunshots in order to reduce gun violence was more important that maintaining confidentiality.

I don't think the study means that health professionals can afford to be cavalier about violating patient confidentiality.  On the contrary, it means front line health care providers must be vigilant to creeping invasions of patient privacy.  Here in Canada, initial reaction from some medical groups was mixed. The arguments they used were that the injured, fearing being confronted by police, would refrain from seeking care.  They also expressed fears that an obligation to report gunshot wounds today becomes an obligation to report knife wounds tomorrow and punches and kicks soon after. A follow up survey indicates that mandatory reporting of gunshot wounds has been accepted in Ontario by health professionals and by the public. Other provinces are following Ontario's lead. 

Still, health care professionals have every right to know where the desire by law enforcement to gather intelligence ends and whose rights are being violated in the process.