MEDICAL CONFIDENTIALITY

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MEDICAL CONFIDENTIALITY

• Dr T Thirumoorthy
• SMA Centre for Medical Ethics and Professionalism
• September 13 2001

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Medical Confidentiality

• Respect for confidentiality is firmly established
  in codes of medical ethics
• Hippocratic oath
• whatever in connection with my professional
  practice, or not in connection with it, I see or
  hear in the life of men,which ought not to be
  spoken of abroad, I will not divulge as
  reckoning that all such should be kept secret

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Medical confidentiality

• International Code of Ethics
• Except when obligated by the law of the country
  concerned, a doctor shall not disclose, without
  the consent of the patient, information which he
  has obtained in the course of his professional
  relationship with the patient

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Medical confidentiality

• SMC Physicians Pledge
• I solemnly pledge to
• respect the secrets which are confided
  in me

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Medical confidentiality - definitions

• foundation of trust in D-P relationship
• a person puts trust and confidence in another to
  act in good faith for his best interest
  fiduciary relationship
• privileged communication intended only for the
  knowledge of a particular person - confidential
  communication

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Medical confidentiality - definitions

• Keep private information secret or undisclosed
• children, elderly, mentally disabled and the dead
  all have the same right to confidentiality

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Medical confidentiality-why is it important

• natural human desire for privacy
• fear of social embarrassment or disapproval
• fear of discrimination, stigmatisation
• Information misused against patient

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Medical confidentiality-why is it important

• builds confidence and open communication
• demonstrates doctors fidelity to the patient
• respects patients privacy, dignity and
  individuality

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Medical confidentiality-why it is important

• Encourages free exchange of information which is
  critical for
• effective medical intervention
• public health effort
• preventing harm to others

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Medical confidentiality-importance

• Medical confidentiality respects patient autonomy
• right to determine with whom, when and how much
  of personal medical information is shared

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Medical confidentialitywhen is it critical

• sexual history STD
• adolescent sexuality
• alcohol drug dependence
• psychiatric conditions
• marginalised persons

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Medical confidentiality-principles of disclosure

• Medical confidentiality is not absolute
• Disclosure -
• to proper authorities- need to know
• not beyond what is required or relevent
• reason for disclosure documented in the
  medical records
• inform patient that such disclosure is
  required

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Medical confidentiality- disclosure

• with patients consent
• for benefit of patient
• prevent harm to others
• when required by Law
• medical research,audit,registries

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Medical confidentiality- disclosure with
patients consent

• Should be attempted at all times possible
• Patient understands nature effects of disclosure
• Reports to 3rd parties(insurance,employer,) must
  always be with consent - written consent
• Husband/ wife/ family cannot be implied

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Medical confidentiality-disclosure with
patients consent

• Consent should be written, original , addressed
  to a named doctor
• Clear indication of reason material
• Informed vs Valid Consent - capacity,voluntary
• Hand document to patient - free to pass on himself

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Medical confidentiality- disclosure for
patients benefit

• In times of emergency
• Patient is incompetent
• Implied consent when care is shared among
  professionals - only necessary information for
  effective care of patient
• For the benefit of patients care
• To prevent harm to patient - epilepsy, child
  abuse

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Medical confidentiality-disclosure to prevent
harm to others

• When harm to others outweighs his duty to the
  patient
• seriousness of harm vs likelihood of occurrence
  of harm
• to whom to tell how to tell
• disciplinary action against doctor

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Medical confidentiality-disclosure required by
Law

• Order of court - medical litigation,coroners
  court, criminal cases, compensation
• Drug abuse in Singapore
• Public health risk - Infectious Diseases Act
• Factories (Medical Examinations) Regulations 1985
• Enlistment Act for national service

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Medical confidentiality-disclosure for medical
audit, research,registeries

• approved by ethics committee
• ensure no harm to patient
• delink patients identifiable data
• registries operated under principle of medical
  confidentiality
• where feasible get consent or inform patient

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Medical confidentiality- medical certificates

• Medical certificates for claiming benefits
• Patients and NOT doctors responsibility to pass
  the information
• Doctor hands the info to the patient - marked
  Private Confidential
• Correct diagnosis written after informing patient
  the possible implications

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Medical confidentialityethical dilemmas/special
situations

• Company/Managed care
• Occupational physicians
• Maids Employment examination
• Armed Forces Medical Officer
• Police Prisons Doctor
• Electronics Medical Records

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Medical confidentiality-a culture of
professionalism

• Loose talk, corridor and lift gossip
• Doctors not to look at MR of patients not in
  their care
• Nurses, secretaries and attendants
• Conversation,MR, telephone faxes
• Confidentiality consciousness

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Medical Confidentiality-conclusions

• All medical information that doctors acquire as
  part of the professional practice is subject to
  the Duty of Confidentiality
• Confidentiality is not absolute
• Disclosure should only occur with consent, for
  benefit of patient or with just grounds for
  disclosure

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