Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Use consented and, when justified, proportionate collateral information to establish baseline, chronology, function, treatment response and risk while protecting confidentiality, documenting source reliability and preserving the person's own account.
A single interview is a sample of a fluctuating life. Ask what the person was like before the present change and map the earliest symptom, progression, crises, admissions, treatment trials, adherence, adverse effects, substance exposure, physical illness and recovery. Functional examples are often more reliable than adjectives: missed rent, abandoned cooking, three nights without sleep, stopped collecting children or returned to work. Date uncertainty should be recorded as approximate rather than converted into false precision.
Seek permission early and offer control. The person may agree to contact a partner about medicines but not trauma, or a GP about diagnoses but not family. Explain that someone can provide information without automatically receiving information. Identify communication needs and consider separate conversations so both parties can speak freely. With children or dependent adults in the household, clarify actual caregiving tasks and current safety rather than assuming either danger or protection from a diagnostic label.
A supporter describes a clear loss of established sleep, work, self-care, judgement or social function compared with the person's usual pattern.
Distinct periods of symptoms and recovery, especially around treatment or substance changes, can discriminate diagnoses more effectively than a cross-sectional presentation.
The informant has limited opportunity to observe, a significant conflict, uncertain recall or an interpretation that exceeds the concrete facts supplied.
Another person controls access, answers every question, contradicts with intimidation or prevents private contact, prompting a safe safeguarding assessment.
New information describes a specific, credible and near-term danger that may justify proportionate action even when ordinary sharing permission is absent.
A clinician may listen to a concerned relative even when confidentiality prevents confirming attendance, diagnosis or the content of care.
Observable changes in work, money, sleep, parenting or self-care often date an episode more reliably than retrospective symptom labels.
Repeated statements can appear corroborated when every note derives from one original account, so trace important claims to their source.
A patient may authorise questions about medication and safety while withholding other sensitive subjects, and the agreed boundary should be respected.
Different accounts may expose memory difficulty, coercion, shame, altered insight or distinct observation periods rather than simple dishonesty.
Refusing to hear urgent information because the patient has not consented to disclosure.
Treating next of kin as a legal power or unrestricted recipient of confidential information.
Contacting a relative secretly for convenience when no safety or legal justification exists.
Documenting the informant's diagnosis of the patient as though it were an observed fact.
Using collateral to erase the patient's account rather than explaining differences.
Ignoring the possibility that the proposed informant is abusive, coercive or conflicted.
Failing to record why non-consensual information sharing was necessary and proportionate.
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A patient's brother telephones to report that the patient bought a weapon and made a specific threat. The patient has not consented to family discussion. What should the clinician do?
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Confidentiality has limits but disclosure is not all-or-nothing. With consent, share information needed for agreed care. Without consent, consider whether the person lacks capacity and sharing is necessary for their overall benefit, whether safeguarding duties apply, or whether failure to disclose exposes the patient or others to a risk of death or serious harm. Use the minimum necessary information, an appropriate recipient and secure method. Record what was considered, advice sought and why the anticipated benefit outweighed the intrusion.
Use longitudinal evidence to test the formulation. Episodic activation independent of substances differs from constant impulsivity; cognitive fluctuation with infection differs from years of decline; symptom remission after stopping a medicine may alter causation. However, collateral information remains evidence rather than verdict. Preserve the person's voice, communicate unresolved differences and ensure significant new facts change the plan rather than merely lengthen the notes.