CONFIDENTIALITY

DR SAMIN AMIN

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What is the difference between Privacy and
Confidentiality?

Privacy is about people.

Confidentiality is about data.

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 Privacy vs. Confidentiality
Privacy
About people
Sense of being in control of
access that others have to
ourselves
a Right to be Protected
Confidentiality
Extension of privacy
About identifiable data
an Agreement about
maintenance and who has access
to identifiable data
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 Definitions

Privacy about people and our sense of being in

control of others access to ourselves or to
information about ourselves with others.

Confidentiality treatment of identifiable,

private information that has been disclosed to
others; usually in a relationship of trust and with
the expectation that it will not be divulged
except in ways that have been previously agreed
upon.

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Measures to respect confidentiality
Avoid identifiable data
Encode the collected data
Limit access to data
Keep in password-protected PC
Destroy the original copies after analysis, or
publication
To each of the previous conditions, there
are ethically-acceptable exceptions

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Where does the duty of confidentiality come from?

Patients share personal information with physicians. You have a duty as a

physician to respect the patient's trust and keep this information private.
This requires the physician 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.

The obligation of confidentiality both prohibits the physician from disclosing

information about the patient's case to other interested parties and
encourages the physician to take precautions with the information to ensure
that only authorized access occurs. Yet the context of medical practice does
constrain the physician's obligation to protect patient confidentiality.

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 What does the duty of confidentiality require?
In the course of caring for patients, you will find yourself
exchanging information about your 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.
Computerized patient records pose new and unique
challenges to confidentiality. You should follow prescribed
procedures for computer access and security as an added
measure to protect patient information.

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 What kinds of disclosure are inappropriate?

Inappropriate disclosure of information can occur in clinical settings.

When pressed for time, the temptation to discuss a case in the
elevator may be great, but in that setting it is very difficult to keep
others from hearing the information exchanges.

Similarly, extra copies of handouts from teaching conferences that

contain identifiable patients should be removed at the conclusion of
the session. The patient's right to privacy is not being respected in
these sorts of cases.

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 When can confidentiality be breached?

Confidentiality is not an absolute obligation. Situations arise

where the harm in maintaining confidentiality is greater than
the harm brought about by disclosing confidential
information.

You should ask - will lack of this specific information about

this patient put a specific person you can identify at high risk
of serious harm? Legal regulations exist that both protect and
limit your patient's right to privacy, noting specific exceptions
to that right.

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 A practitioner can disclose
personal information if;
(MMC, Confidentiality Guidelines, 2011)
(a) it is required by law (paragraphs 15-20);
(b) the patient consents either implicitly for
the sake of their own care or expressly for
other purposes;
(c) it is justified in the public interest
(paragraphs 34-48)

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Case
Your 36-year-old patient has just tested positive
for HIV. He asks that you not inform his wife of the
results and claims he is not ready to tell her yet.

What is your role legally? What would you say to

your patient?

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Case cont.

Because the patient's wife is at serious risk for

being infected with HIV, you have a duty to ensure
that she knows of the risk. While public health law
requires reporting both your patient and any known
sexual partners to local health officers, it is
generally advisable to encourage the patient to
share this information with his wife on his own,
giving him a bit more time if necessary.

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Case
A 75-year-old woman shows signs of abuse
that appears to be inflicted by her husband. As
he is her primary caregiver, she feels
dependent on him and pleads with you not to
say anything to him about it.
How is this case different from Case 1? How
would you handle this situation?

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Case cont.
In this case, the doctor may feel conflicted. A vulnerable elderly woman needs
protection and may be fearful of her abusive husband. Reporting to Adult
Protective Services, required if the physician suspects elder abuse may also
make the patient fear that she will be exposed to further abuse by her enraged
husband. The therapeutic alliance with the patient provides a unique
opportunity to support the patients health and safety. The physician should
discuss services that might be available to assist her; encourage the woman to
seek help; provide medical care and counseling; and explain the physicians
duty to report. It should also be noted that anyone who suspects elder abuse is
required to report it - neighbors, social workers, family members, etc.
Whenever the safety of an individual is at stake, confidentiality may be
breeched and there are usually specific agencies (public health, Child
Protective Services, Adult Protective Services) designated for reporting. These
agencies then assume responsibility for investigating the reports and taking
appropriate steps to ensure the persons safety.

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