Essay on Confidentiality Between Doctor and Patient
Every person has the right of keeping his/her personal information confidential especially about medical conditions. Medical information should be restricted only to the concerned doctor who is authorized to maintain the health record. However, in certain circumstances it becomes necessary for the physician to break this law if it is for the benefit of the patient. Patient confidentially can be described as; medical information should not be disseminated by the doctor and disclosed to any other person or organization until or unless there are specific circumstances requiring distribution of the information or permission has been obtained from patients for disclosure of information.
Thesis statement: it is the ethical and legal duty of doctors to maintain confidentiality of their patients, however, information can be disseminated with the permission of patients and when sharing of information becomes necessary due to seriousness of disease or saving life of the patient.
Proper Handling of Information
Patients generally anticipate that their personal and medical information will be kept secret by the doctors and as such it becomes obligatory for the doctors to perform the duty of confidentiality. All types of information shared by the patients and provided to doctors should be handled carefully and every possible measure should be adopted for protecting such information. In this regard, latest technological advancements are highly supportive for the doctors to maintain confidentiality. (Tingle 123)
The duty of confidentiality is, in fact, a binding contract between the doctor and patient, whether or not such contract is available in written or verbal form. This binding contract forms the basis of relationship between doctor and patient. Moreover, under this relationship it is necessary and compulsory for the doctor to provide care to the patient to the best of his/her capabilities supported by all necessary support available to the doctor. Even the patient is unconscious and care is being provided by the doctor, the contract about providing care and keeping confidentiality is enforced on both doctor and the unconscious patient. However, it should be noted that providing care by the doctor is not compulsory and the doctor has the option to refuse providing care due to any reason which he/she thinks is valid. Confidentiality between patient and the doctor is the basis of medical profession. The confidentiality element is also necessary due to ethical, legal, and moral obligations so that information is kept secret. However, passing or sharing information should be done by taking every possible precaution ensuring safety and security. Keeping confidentiality of the patient is not only the responsibility of doctor but also every one involved including hospital administration, staff etc. (Weber 197)
Public in general and patients in particular expect that not only doctors but also hospitals should undertake every possible precaution and adopt all measures to maintain confidentiality. In this regard hospital records should be maintained in such a way that any breach of confidence does not take place. Any doctor or hospital breaching this ethical or legal duty by disclosing information including medical records may face damages for such disclosure.
There are both legal and ethical considerations for keeping medical/personal information of the patient secret with some exceptions. Law requires maintaining record or information of the patient's health secret but if there is a serious threat to the life or health of a patient then disclosure of the information can be made. Ethical principles also requires that the doctor should try to maintain an accurate but sophisticated balance between the ethical requirement to maintain secrecy and disseminating information to save life or provide care to the patient. (Boyle 145)
In case it becomes ethically and legally a necessity to pass on the information then doctor should discuss the situation with the patient if necessary and also when patient is in the condition to discuss the issue of breaking secrecy. In some instances patient is also encouraged to apprise his/her medical situation to any other person, for instance if the HIV of a patient is positive then the patient should be persuaded to discuss this condition with his/her sexual partner so the related risk is shared between them. However, if the patent is not willing to share the information, then it is the ethical duty of doctor for disclosing information to the person who is exposed to risk. There are certain situations in which doctors should obtain opinion from other doctors. The doctor then should consult a trusted colleague who is expert in that area after getting permission from the patient. (Abrams 143)
Requirements of health insurance companies generally include the clause that patients should waive the condition of confidentiality and disclose the medical information to them when a claim for medical coverage is submitted. In case, a lawsuit is brought by the patient against a hospital or doctor for any particular reason, doctor is then allowed to provide related information and medical records as evidence required in the court. Furthermore, there are legal requirements in some states to disclose and share medical information by the doctors if there is a virus or disease that could harm general public and state should provide protection to the people. Doctors can release information about their patients without breaking law or breaching their ethical duty when patient allows doctors to disseminate the information to specific persons or organizations. In case there is an obligation for the doctors, in the public interest, to disclose information, such as a fatal virus that could spread to harm other people's health, then medical information can be provided to the concerned department after seeking legal advice to avoid any undue circumstances. (Kushner 177)
Ethical and Legal Duty
It is the ethical and legal duty of a doctor to protect the medical as well as personal information of the patient obtained for providing healthcare. This obligation is based on trust, faith, and confidence required in the contract between patient and the doctor. It is necessary that patient should disclose every information he/she has as concealing may result in the failure of doctor for providing care. However, while providing information to the doctor a consent, in written form, should be given to the doctor to release or share any medical information if becomes necessary. Moreover, all employees in the hospital are also required to maintain the confidentiality of patients.
Hospital policies should also be designed and implemented to protect the medical/personal information provided by the patient. The duty of doctor to maintain confidentiality extends to all information obtained directly or indirectly from the patient. Hospital staff involved in keeping confidentiality includes; receptionists, nurses, practice staff, and managers. The contract of secrecy is even applicable after the death of patient. In routine course of business, doctors and hospitals receive requests to release information about their patients from employers, insurers, courts, solicitors, and police; however, the decision to disclose information should be made with due consideration and consultation with legal experts. Furthermore, law also obligates doctors and hospitals to maintain the confidentiality of patients.
For the purpose of maintaining trust and confidence in the doctor-patient relation, it is obligatory for the doctors not to release the genetic or inherited information to anyone including family of the patient without obtaining his/her consent. However, in the case of genetic diseases, doctors should persuade and encourage their patients the significance of disseminating information to at least family members. It is the ethical duty of doctors to inform family members about the genetic risk carried by the patient even if the patient is not willing to disclose the information. For this purpose, it is necessary that doctors, prior to establishing a relationship and initiating healthcare, should obtain the consent of patient to disclose the genetic information to the family members. However, it is pertinent to highlight, that the general rule of maintaining confidentiality should be observed and considered by the doctors as a legal and ethical duty. The disclosure of information about patient's health due to seriousness of disease or saving life of the patient is not banned by law and an ethical duty of the doctor. The doctor, in this case, should try his/her best for obtaining consent of the patient being an ethical duty to pursue patients.
Problems Faced by Doctors to Release Medical Information
Currently, doctors are increasingly being sued by the patients for breaching the relationship requiring maintaining confidentiality and releasing information without the consent of patient. Doctors, therefore, take every possible precaution to avoid any undesired circumstances. Studies have shown the fact that in cases where opinion of other doctors or medical experts is required doctors prior to obtaining medical opinion; sought legal opinion causing a critical delay in providing care to the patients. To resolve this issue, federal as well as state governments have enacted certain laws to ensure confidentiality and also highlighting the situations in which information can be shared without the consent of patient. Some states allow disclosure of medical information in specific conditions and without consent of patients. According to the acts, the information can be provided to other medical experts and also to sources that provide financial assistance to the patient. Furthermore, information can also be provided to researchers and families under particular circumstances. (Jonsen 209)
Discussions have been in the paper about the delicate matter of keeping confidentiality by the doctors about medical conditions of their patients. Although, it is the ethical and legal duty of doctors to keep entire information confidential obtained for healthcare of the patients, there are circumstances in which it becomes necessary to disclose the information. These exception circumstances have also been discussed in the paper.
Abrams, Fredrick Doctors on the Edge: Will Your Doctor Break the Rules for You Sentient Publications, 2006, p. 143
Boyle, Philip Getting Doctors to Listen: Ethics and Outcomes Data in Context Georgetown Univ Pr, 1998, p. 145
Jonsen, Albert Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine McGraw-Hill Medical, 2006, p. 209
Kushner, Thomasine Ward Ethics: Dilemmas for Medical Students and Doctors in Training Cambridge University Press, 2001, p. 177
Tingle, John Patient Confidentiality XPL Publishing, 2002, p. 123
Weber, Leonard Profits before People?: Ethical Standards and the Marketing of Prescription Drugs, Indiana University Press, 2006, p. 197
Confidentiality is one of the core duties of medical practice. It requires health care providers to keep a patient’s personal health information private unless consent to release the information is provided by the patient.
Why is confidentiality important?
Patients routinely share personal information with health care providers. If the confidentiality of this information were not protected, trust in the physician-patient relationship would be diminished. Patients would be less likely to share sensitive information, which could negatively impact their care. Why is confidentiality important?
Creating a trusting environment by respecting patient privacy encourages the patient to seek care and to be as honest as possible during the course of a health care visit. (See also Physician-Patient Relationship.) It may also increase the patient’s willingness to seek care. For conditions that might be stigmatizing, such as reproductive, sexual, public health, and psychiatric health concerns, confidentiality assures that private information will not be disclosed to family or employers without their consent.
What does the duty of confidentiality require?
The obligation of confidentiality prohibits the health care provider from disclosing information about the patient's case to others without permission and encourages the providers and health care systems to take precautions to ensure that only authorized access occurs. Appropriate care often requires that information about patients be discussed among members of a health care team; all team members have authorized access to confidential information about the patients they care for and assume the duty of protecting that information from others who do not have access. Electronic medical records can pose challenges to confidentiality. In accordance with the Health Information Portability and Accountability Act of 1997 (HIPAA), institutions are required to have policies to protect the privacy of patients’ electronic information, including procedures for computer access and security.
What if a family member asks how the patient is doing?
While there may be cases where the physician feels naturally inclined to share information, such as responding to an inquiring spouse, the requirements for making an exception to confidentiality may not be met. If there is not explicit permission from the patient to share information with family member, it is generally not ethically justifiable to do so. Except in cases where the spouse is at specific risk of harm directly related to the diagnosis, it remains the patient's (and sometimes local public health officers’), rather than the physician's, obligation to inform the spouse.
What other kinds of disclosures are inappropriate?
Unintended disclosures may occur in a variety of ways. For example, when pressed for time, providers may be tempted to discuss a patient in the elevator or other public place, but maintaining privacy may not be possible in these circumstances. Similarly, extra copies of handouts from teaching conferences that contain identifiable patient information should be removed at the conclusion of the session in order to protect patient privacy. And identifiable patient information should either be encrypted or should not be removed from the security of the health care institution. The patient's right to privacy is violated when lapses of this kind occur.
When can confidentiality be breached?
Overriding concerns can lead to the need to breach confidentiality in certain circumstances.
Exception 1: Concern for the safety of other specific persons
Access to medical information and records by third parties is legally restricted. Yet, at the same time, clinicians have a duty to protect identifiable individuals from any serious, credible threat of harm if they have information that could prevent the harm. The determining factor is whether there is good reason to believe specific individuals (or groups) are placed in serious danger depending on the medical information at hand. An example is homicidal ideation, when the patient shares a specific plan with a physician or psychotherapist to harm a particular individual.
The California Tarasoff case exemplifies the challenges providers face in protecting confidentiality. In that case a graduate student, Prosinjit Podder, disclosed to a counselor affiliated with Berkeley University that he intended to obtain a gun and shoot Tatiana Tarasoff. Dr. Moore, the psychologist, found Podder’s threat credible. Dr. Moore then faced dual obligations: protect Tatiana Tarasoff from harm and protect Mr. Podder’s confidentiality. Dr. Moore sent a letter to campus police about the threat. They spoke to Mr. Podder, told him to stay away from Tatiana, but determined he was not a danger to her. He later stalked, stabbed and killed Tatiana. Tatiana’s parents sued campus police and the university’s health service for failure to warn Tatiana. The lower court refused to hear the case, claiming that Dr. Moore had an obligation to protect Podder’s confidentiality. Tarasoff’s parents appealed and the California Supreme Court ruled that, “the discharge of this duty may require the therapist to take one or more of various steps. Thus, it may call for him to warn the intended victim, to notify the police, or to take whatever steps are reasonably necessary under the circumstances.” (Ref. Tarasoff case).
The implication of this ruling is that a duty to warn third parties of imminent threats trumps a duty to protect patient confidentiality, however, it is usually difficult for a therapist or health care provider to accurately ascertain the seriousness and imminence of a threat. Tarasoff has subsequently been interpreted to endorse the provider’s duty to warn when a patient threatens an identifiable victim. Ethically, most would agree that a duty to warn an innocent victim of imminent harm overrides a duty to confidentiality, but these cases are rare and judgment calls of this sort are highly subjective. Hence, the duty to maintain confidentiality is critical, but may be overridden in rare and specific circumstances.
Exception 2: Legal requirements to report certain conditions or circumstances
State law requires the report of 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. For example, reportable diseases in Washington State include (but are not limited to): measles, rabies, anthrax, botulism, sexually transmitted diseases, and tuberculosis. Suspected cases of child, dependent adult, and elder abuse are reportable, as are gunshot wounds. Local municipal code and institutional policies can vary regarding what is reportable and standards of evidence required. Stay informed about your state and local policies, as well as institutional policies, governing exceptions of patient confidentiality.
A Test for Breach of Confidentiality
In situations where you believe an ethical or legal exception to confidentiality exists, ask yourself the following question: will lack of this specific patient information put another person or group you can identify at high risk of serious harm? If the answer to this question is no, it is unlikely that an exception to confidentiality is ethically (or legally) warranted. The permissibility of breaching confidentiality depends on the details of each case. If a breach is being contemplated, it is advisable to seek legal advice before disclosure.
What are the confidentiality standards regarding adolescents?
In many states adolescents may seek treatment without the permission of their parents for certain conditions, such as treatment for pregnancy, sexually transmitted infections, mental health concerns, and substance abuse. Familiarize yourself with state and local laws, as well as institutional policies, regarding adolescents and healthcare.