Patient Confidentiality

Healthcare professionals need to be aware of the principles of confidentiality and other aspects associated with it, says Dr Suganthi Iyer

One of the important rights of a patient is that of confidentiality. Doctors and other healthcare professionals need to be aware of the principles of confidentiality and other aspects associated with it. Outlined below are some of the broad aspects regarding the principles of confidentiality regarding patients.

Section 1

Patients' right to confidentiality:

• Patients have a right to expect that information about them will be held in confidence by their doctors.
• The healthcare personnel should seek patients' consent before disclosure of any information.
• Anonymise data where unidentifiable data will serve the purpose. Anonymised data means data from which the patient cannot be identified by the recipient of the information.
• Keep disclosures to the minimum.
• When responsible for personal information about the patients, protect the same against improper disclosure.

Section 2

Sharing information with patients:

• Patients have a right to information about healthcare services available to them.
• Patients also have a right to information to the disease from which they are suffering.
• It is a good practice to give patients information about how anonymised data about them may be used to protect public health, undertake research and audit, train medical staff and organise healthcare services.

Section 3

Disclosure of information:

• Where patients have consented to treatment, expressed consent is not usually needed before relevant information is shared to enable treatment to be provided as doctors cannot treat patients safely nor provide continuity of care without having relevant information.
• The patients must be aware that personal information about them will be shared within the healthcare team and the reasons for this.
• Make sure that anyone to whom you disclose personal information understands that it is given to them in confidence.
• Circumstances may arise where a patient cannot be informed about sharing of information as in emergencies.

Section 4

Disclosure of information other than treatment of individual patient:

• Principles: Information about patients is requested for wider purposes including education, research, epidemiology, public health surveillance, medical audit, administration and planning. One has to follow the guidelines set out in Sec 1.
• Obtaining consent: As in the case of disclosing personal information to the employer, if consent cannot be obtained, disclosure to be made only if justified in public interest.
• Data may be disclosed without consent only if it is not practicable to obtain consent or anonymise records. However, disclosure should be kept to a minimum. Patients also have to be told that their records may be disclosed outside the healthcare team, anonymised data will be provided, records will be given subject to confidentiality, and that the patients have a right to object which will be respected except otherwise in public interest.

Disclosures in public interest is done when it is not practicable or patients are not competent to give consent or when consent is withheld, but where benefit to society outweighs the patient's interest as determined by the courts.

Section 5

Implementing the principles into practice:

• Disclosure with respect to notification of communicable diseases as referred by law preferably in anonymised forms.
• Record objection of the patients and in such cases anonymised information may be given if asked to do so.
• Public interest to be considered.
• Where it is not practicable to seek patients' consent or if the patient is not competent, disclosure is justified only in public interest.
• Transfer of information to a registry without informing the patient is unacceptable except if decided by a court that it is in public interest.
• Anonymised data is usually sufficient for clinical audit and education. Do not disclose non-anonymised data without patients' consent. Anonymised data should suffice administrative and financial audit.

Medical Research

Disclosures where doctors have dual responsibilities: Identifiable information to be given only after consent or a claim for breach of confidentiality can be made. Of course public interest will be taken into consideration. Patients' consent is to be obtained before publishing case histories and photographs. As in the case of providing health service for employees of an organisations like insurance company, working as police surgeons, working in Armed Forces, working in prison service, information asked by third parties, the following guidelines are to be adhered to:

• Inform the patient about the disclosure.
• Obtain written consent.
• Disclose information which is relevant.
• Disclosure to be done in an unbiased manner.
• Disclosure without consent to be done only in public interest or necessary to protect others from risk of death or serious harm.
• Disclosure to protect the patient or others is done when failure to do so would expose patients or others to the risk of death or serious harm e.g. where a colleague who is also a patient is placing other patients at risk due to illness.
• Where a disclosure may assist in prevention, detection or prosecution of serious crime.
• There is also an obligation to keep personal information confidential, even after the patient dies.

Section 6

Disclosure in connection with judicial or other statutory proceedings:

• Notification of communicable disease.
• Information in a court.
• Information to a solicitor/police officer.
• Public interest.

If you decide to disclose confidential information you must be prepared to justify and explain your decision.

Electronic Processing

• Appropriate arrangement of security of personal information must be made when it is told, sent or received by fax, computer, e-mail or other electronic means.
• Appropriate authoritative professional advice should be given on how to keep information secure before connecting to a network.
• Make sure your own fax machine or computer terminals are in secured areas.
• Note that information sent by e-mail or internet may be intercepted.

The writer is Assistant Director, Medical Services and Legal, PD Hinduja Hospital, Mumbai.
Email: dr_siyer@hindujahospital.com