Confidentiality and the

Management of Health Care

Information
 Confidential
Adjective
Define as
spoken, written, acted on, etc., in strict privacy or 

secrecy; secret: a confidential remark.

indicating confidence or intimacy; 

imparting private matters: a confidential tone of voice.

having another's trust or confidence; entrusted with secretsor priva
te affairs: a confidential secretary.
The Patient’s Bill of Rights
“ The patient has a right to every
consideration if privacy concerning his
own medical care program. Case
discussion, examination, and treatment
are confidential and should be conducted
discreetly. Those not directly involved in
his care must have the permission and
records pertaining to his care should be
treated as confidential. “
 Confidentiality in a Utilitarian Point of
View
The long term consequences of making public any personal
information gained as a result of practitioner/patient relationship
would have a chilling effect upon the truth telling in that
relationship.

Normally health care practice is under the a tacit agreement of

confidentiality, practitioners who breach this trust are in
violation of an agreed-upon expectation. ( esp. cases on
psychotherapy)

If the patient has lost confidence and fails to discuss personal
issues with the practitioner the amount of care will be severely
limited.
 Confidentiality in a Duty Oriented
Perspective
Personal privacy is a basic right, not only in
professional practice but also in law.
Ex. Disclosure of patients private affairs, unauthorized
use of a person’s photo, or exploitation of a person’s
name. These things are considered to be grounds of
invasion of an individuals right to privacy.
The medical duty to protect the confidentiality of
patients could be basis of our general rights as citizens
to be free from invasion of privacy.
Privacy as a person’s right while confidentiality is the
professionals duty.
Vantage Point of Virtue Ethics
Confidentiality has been corporate with the health
care practice and forms one of the virtue that one
would expect from a “good practitioner”
Confidentiality a critical principle and regardless
of the specialty the “good practitioner” cannot be
viewed as an inconsiderate in regard to protection
patients confidences and privacy.
Practitioners shares information with each other
but does not take in forms of conversation in
cafeterias, or with friends at a party.
Tarasoff Case
Prosenjit Podder – a young man that was
committed and evaluated by the health
care practitioner because of the potential
danger to a woman named Tatiana. And
was realeased after he convinced that he is
in a rational state of mind.
Tatiana - murdered by Prosenjit
Courts Decision
Court recognized that a practitioner might
have in a tempting to predict whether
statements made by a patient would actually
be carried out.

The court ruled that the specialist would be

held to the standard of reasonable practice;
and where the standard indicated a
foreseeable danger to another, a duty to warn
was created.
Theprotective privilege of confidentiality is LIMITED
where the SAFETY of OTHERS is INVOLVED.

Breaching of trust of confidentiality is recognized and

ALLOWED by the Principles of Medical Ethics of the
American Medical Association which states that:
“A physician may not reaveal the confidences
entrusted to him in the course of medical
attendance. . . Unless he is required to do so by the
law or unless becomes necesarry in order to protect
the welfare of the individual or of the community.”
Confidentiality
Secrets: On the Ethics of Concealment and
Revelation by Sissela Bok
1. Keep all clients records secure.
2. Consider carefully the content to be entered into the record.
3. Release information with the written consent and full
discussion of the information to be shared, except when
release is required by the law.
4. Use professional judgement deliberately reagarding
confidentiality when the client is a danger to self or others.
5. Use professional judgement deliberateley when deciding
how to maintain the confidentiality of a minor. The right of
parents/guardian must also be considered.
6. Disguise clinical material when used professionally for
teaching and writing.
Harm Principle
Bok feels that the privilege of confidentiality is
limited by this principle.
The principle requires the health practitioners
refrain from acts that would foreseeable result in
harm to others.
Modified by Level of Vulnerability.
Case of a married man with HIV positive. The risk
to community at large is minimal while the risk is
regards to discrimination, deprivation of rights and
occupational and social harms are GREAT.
Confidentiality and Genetic Science
Employment, Insurance are affected.
The issues of confidentiality with right to
know?
Ex. A teenager who were tested to be (+)
in HD, could the information be kept in
the spouse. Parent who were tested
positive should they keep it on his
children.
CASE STUDY: Confidentiality vs. A Right
To Know
Modern Health Care and Confidentiality
Early 1900’s 85% of direct medical care services were
delivered by the physicians. Today 80% of direct patient care
is provided by allied health and nursing professionals.
The patient record is not only accessible to the physicians but
also to the host technical and administrative staff who
generate and handle the patient data.
The access of insurance companies, public health agencies,
employers, federal state and local government, attorneys and
law enforcement agencies, media.

Third Party Payers (insurers/utilization reviewers) they may

favor safety, truth and knowledge rather than the value of
patient privacy.
Legal Perspective to Medical Record
Access
Common Legal Reporting Req.
Child abuse
Drug abuse
Communicable Dxs.
Injuries with guns or knives
BT reactions
Poison and industrial accidents
Misadministration of Radioactive Materials
“Any physician, hospital administrator and personnel engaged
in examination, care, and treatment of persons..

Having reasonable cause to believe that a child known to them

in their professional or official capacity may be an abused
child or neglected child shall immidiately report or case a
report to be made.

The privilegad quality of communication between any

professional person required to report and his parents or
client shall not apply to situations involving abused or
neglected annd shall not constitute grounds for failure to
report as required by this Act.”
Legitimate Interest
Medical record goes far beyond medical
information and contains personal data of
a financial and social nature.
The exact specification of who has a
legitimate interest is a great concern to
health care practitioners.
For Professional Education
Medicine, nursing, allied health,
psychology, social services, or any
professional groups involved in patient
care.
Administrative Functions
Limited amounts of information as
needed for the administrative functions
such as admission, discharges, billing,
compiling census data.
Duly appointed quality of care Auditors
Governmental third party payers and
professional review organization have
legitimate access to patient record.
Institutional Review Boards (IRB’s)
 To balance the potential risk to the patient agains the
potential benefits of the research.
1. The research should not be presented in such a fashion
as to protect the anoniminity of the patients.
2. Only those involved in the study will have the access
to the raw data.
3. safeguards to protect the patient’s privacy will be
party of the research protocol.
4. The same level of obligation to maintain patient
confidentiality in the practice of health care is
expected in the conduct of medical reasearch.