Where does the obligation of
confidentiality come from? Confidentiality is one of the basic tenets of medical
practice and each day doctors face challenges to this
long-standing obligation to keep all information between physician
and patient private.
Patients share personal information with physicians and the doctor
has a duty to respect the patient's trust and keep this
information private. This requires the doctor to respect the
patient's privacy by restricting access of others to that
information. Furthermore, creating a trusting environment by
respecting patient privacy can encourage the patient to be as
honest as possible during the course of the visit.
What does confidentiality require? It not only prohibits the physician from disclosing
information about the patient's case to other interested parties
but also encourages the physician to take precautions with the
information to ensure that only authorized access is permitted.
Yet the very act of medical practice does constrain this
obligation to protect patient confidentiality as in the course of
caring for patients, doctors exchange information about their
patients with other physicians. These discussions are often
critical for patient care and are an integral part of the learning
experience in a teaching hospital. As such, they are justifiable
so long as precautions are taken to limit the ability of others to
hear or see confidential information. Computerised patient records
pose new and unique challenges to confidentiality and prescribed
procedures for computer access and security must be followed as an
added measure to protect patient information.
What kinds of disclosure are
inappropriate? Inappropriate disclosure of information can occur in
several clinical situations. Paucity of time may often lead to the
temptation to discuss a patient in informal settings
(cafeteria/staircase). Privacy of information exchanged in such
settings is compromised, as it is difficult to keep others from
over hearing. Similarly, information used for teaching purposes
that contain identifiable patients should be removed as the
patient's right to privacy is not being respected in these sorts
of cases.
When can confidentiality be breached? Confidentiality is not an absolute obligation and
situations may arise where the harm in maintaining confidentiality
is greater than the harm brought about by disclosing such
information. In general, two such situations that may give rise to
exceptions exist and in each situation, the doctor has to consider
- will lack of this specific information about this patient put a
specific person at high risk of serious harm? Legal regulations
may exist that both protect and limit patient's right to privacy,
noting specific exceptions to that right.
These exceptions follow.
1. Concern for the safety of other specific persons
Doctors have a duty to protect identifiable individuals from any
serious threat of harm if they have information that could prevent
the harm. Such breach of confidentiality is justified if there is
good reason to believe specific individual(s) is/are placed in
serious danger depending on the medical information at hand.
2. Concern for public welfare
The most common example of this sort of exception is that of
homicidal ideation, when the patient shares a specific plan with a
physician or psychotherapist to harm a particular individual. This
justifies breaking the traditional patient confidentiality.
Limited confidentiality exists when the doctor is required by law
to report certain communicable/infectious diseases to the public
health authorities. In these cases, the duty to protect public
health outweighs the duty to maintain a patient's confidence. From
a legal perspective, the State has an interest in protecting
public health that outweighs individual liberties in certain
cases. Local laws may vary regarding what is reportable and
standards of evidence required.
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