A patient with schizophrenia tells you in confidence during a consultation that he is planning to harm a specific individual. What do you do?
- Confidentiality is not absolute - it can be breached where there is a risk of serious harm to an identifiable third party
- GMC guidance (Confidentiality: Good Practice in Handling Patient Information, 2017): disclosure without consent may be justified in the public interest if failure to disclose may expose others to a risk of death or serious harm
- In the UK there is no specific statutory "duty to warn" as in the US (Tarasoff), but there is a professional and ethical obligation to act
- Consider: the specificity and credibility of the threat, the patient's mental state, the imminence of the risk
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How to approach this Psychiatry interview question
This ethics question is common in Psychiatry NHS interviews because it reveals how you think under interview pressure, not just what facts you can recall. Use "A patient with schizophrenia tells you in confidence during a consultation that he is..." as the anchor for a concise answer with a clear opening, a clinical or professional structure, and a reflective close.
What the panel is testing
A strong ethics answer makes the competing duties visible. Name the principle or legal issue, then describe the practical steps you would take in the hospital: gather facts, assess capacity where relevant, seek advice, document, and protect the patient. For psychiatry, risk assessment, capacity, legislation, rapport, and multidisciplinary planning are usually central. Keep the answer humane, structured, and legally aware.
- Identify the ethical tension before jumping to a decision: capacity, consent, confidentiality, best interests, or law.
- Use local policy and senior advice, and be explicit about safeguarding or immediate patient-safety concerns.
- Balance respect for autonomy with professional duties, documentation, and clear communication.
How to structure your answer
For a ethics prompt, aim for a short opening sentence, then two or three evidence-led points, then a final reflection. If you use STAR, keep the result and reflection as strong as the situation. If it is a clinical scenario, say what you would do now, what you would do next, and how you would keep the patient safe while help is coming.
- Open by naming the main issue in the question.
- Give a structured response rather than a memorised script.
- End with escalation, documentation, learning, or follow-up.
Common mistakes to avoid
The weakest answers usually stay too vague, ignore the specific role, or miss the safety issue hidden in the question. Do not use this page to memorise a perfect paragraph. Use it to rehearse the shape of a safe answer, then adapt it to your own experience and the post you are applying for.
- Confidentiality is not absolute - it can be breached where there is a risk of serious harm to an identifiable third party
- GMC guidance (Confidentiality: Good Practice in Handling Patient Information, 2017): disclosure without consent may be justified in the public interest if failure to disclose may expose others to a risk of death or serious harm
- In the UK there is no specific statutory "duty to warn" as in the US (Tarasoff), but there is a professional and ethical obligation to act