Sir, pertinent to Peter Ward's editorial (Br Dent J 2015;219: 145), Wood (Br Dent J 2015;218: 439) raises an important issue with regard to the disparity in guidelines on patient confidentiality issued by the GDC and GMC. Recently a (GMC-registered) consultant histopathologist from another hospital sent me (a GDC-registered oral pathologist) the histological sections of a gingival biopsy from a female patient aged 50 for a second opinion. The clinical diagnosis was of an epulis, but the histopathologist was concerned at the possibility of an odontogenic myxoma, a rare but destructive tumour of the jaws. Review of the histological sections showed non-specific microscopic features, but the differential diagnosis indeed included odontogenic myxoma. To establish a definitive diagnosis required further clinical information and access to the radiographs. Normally, this would be a simple matter of speaking to the clinician concerned (who, usually, is hospital-based) and requesting the radiographs from the referring hospital, which would then be electronically transferred via secure means. Had the patient had the biopsy in hospital, her consent to allow anybody involved in her management to view the radiographs would have been implicit when she consented to the biopsy procedure. However, on this occasion the biopsy had been taken by a dental surgeon in practice and sent to the referring hospital for diagnosis. The dental surgeon was contacted and asked to forward the radiographs, but refused to do so without the patient's written consent, citing GDC guidelines on patient confidentiality. Fortunately (though perhaps inconsistently), she was prepared to discuss the case on the telephone, and assured me that clinically the lesion was a typical epulis, that the radiographs did not show any evidence of a neoplasm, and that she would arrange appropriate follow-up. I, therefore, issued a histopathology report which included the rider that the radiographs were unavailable for examination. As I have heard nothing further in ten months I am hopeful the correct diagnosis was made. When it issued its guidelines on patient confidentiality, one imagines the GDC did not intend to frighten dentists into obstructing the diagnostic process, but that is what appears to have been achieved in this case.

1. West Sussex