CONFIDENTIALITY

Submitted to: Prof...... Submitted by: Dr. Aastha Sandeep Dr. Arshad Dr. Gurpreet Kaur Dr. Jyoti Sharma Tarun walia

Definition
Right of confidentiality is the right of individual patient to have personnel , identifiable medical information which is kept private and such information should be available only to the physician and other healthcare providers including insurance personnel as well if necessary.

Concepts concerning confidentiality

1. 2. 3.

4.
5.

Do no harm Be honest Use information proactively Irreversible Threat of self destruction

1. Do no harm It means that the resident and healthcare provider will have an honest relationship in which sensitive data should be and shall be disclosed at no risk to the resident or client that there will not be a breach in confidential issues.
2. Be honest - Deal honestly with residents and families, and also your peers. Dont be afraid to admit a mistake.

3. Use information proactively- Information shared will be used for the sole purpose of being accurate in diagnosis, prescribing the best recommended treatment, and providing the best care.

4. Irreversible- Information once shared cannot be unshared, erased, or deleted. Think about what you are saying before words fall out of your mouth.
5. Threat of self destruction - A claim of confidential or private matters can not be honored if concealment poses a threat to the resident or client

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

Respect for confidentiality is firmly established in codes of medical ethics

Medical

disclosed to a physician during the course of the patient-physician relationship is confidential to the utmost degree. Patient confidentiality is a legal duty as well as an ethical duty. Electronic health information systems allow increased access and transmission to health data.

Ethics states that the information

The Medical Council of India`s Code of Ethics Regulations (5) protects patient confidentiality by stating that the physician "shall not disclose the secrets of a patient that have been learnt in the exercise of his/her profession except in a court of law under orders of the Presiding Judge; in circumstances where there is a serious and identified risk to a specific person and/or community; [or in case of] notifiable diseases."

Central Government Act

Section 30.

30 in The Industrial Disputes Act, 1947

Penalty for disclosing confidential information.Any person who willfully discloses any such information as is referred to in section 21 in contravention of the provisions of that section shall, on complaint made by or on behalf of the trade union or individual business affected, be punishable with imprisonment for a term which may extend to six months, or with fine which may extend to one thousand rupees, or with both.

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

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
communication intended only for the knowledge of a particular person -

privileged

confidential communication

 Keep

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

children,

Medical confidentiality -why is it important

Natural Fear Fear

human desire for privacy

of social embarrassment or disapproval of discrimination, stigmatization.

Information

misused against patient

 Builds

confidence and open communication doctors fidelity to the

Demonstrates

patient

Respects

patients privacy, dignity and individuality

Encourages free exchange of information

which is critical for: Effective medical intervention Public health effort Preventing harm to others Medical confidentiality respects patient autonomy Right to determine with whom, when and how much of personal medical information is shared

When it is critical
Sexual

history & STD Adolescent sexuality Alcohol & drug dependence Psychiatric conditions Marginalized persons

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

Principles of disclosure
To proper authorities- need to know Not beyond what is required or relevant Reason for disclosure documented in the medical records Inform patient that such disclosure is required.

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

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

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

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

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

Breach of Confidentiality
A

breach of confidentiality is a disclosure to a third party, without patient consent or court order, of private information that the physician has learned within the patientphysician relationship. Disclosure can be oral or written, by telephone or fax, or electronically, for example, via e-mail or health information networks.

The legal basis for imposing liability for a breach of confidentiality is more extensive than ethical guidelines, which dictate the morally right thing to do. There are two types of OUTCOMES related to breach of confidentiality . Positive outcome Negative outcome

a.

b.

Positive outcomes
1. 2.

3.
4.

Suspected abuse or neglect can be investigated Possible future abuse and neglect may be avoided or prevented A suicide or attempted suicide may be prevented Appropriate interventions may be initiated for a resident or client to get help in appropriate related areas.

Negative Outcomes
1.

2. 3. 4.

The facility or agency may reprimand a healthcare worker, such as disciplinary action against the employee for breaching confidentiality related to patient care issues. The resident or client may suffer embarrassment and emotional distress Irreversible damage may be done to the caregiver/ care receiver relationship. The resident or client may file charges against the healthcare worker, staff, and facility. They may be able to sue and win compensation for breach of confidential matters.

Confidentiality Vs privacy
Confidentiality
Extension

Privacy
About

of privacy About identifiable data an Agreement about maintenance and who has access to identifiable data HIPAA - protects
patients from inappropriate disclosures of "Protected Health Information" (PHI)

people Sense of being in control of access that others have to ourselves a Right to be Protected

STEPS FOR GOOD RESULTS

Train

your staff Establish and Check Workforce Clearance Procedures Use Improved Security Measure Effective Workforce Termination Review System Activity Keep Data in Encrypted Mode Periodic Security Reminder

Benefits of Maintaining Confidentiality

It

helps establish trust between the patient and the healthcare provider. reduces worry on the part of the patient. maintains the patients dignity. patient feels respected.

It It

The It

gives the patient control and promotes autonomy and participation.

CASE

Velazquez vs. St. Clare's Hospital. (Kings County Supreme Court, New York, 1994). Nydia Velazquez was admitted to St. Clare's Hospital in 1991 after attempting suicide. In 1992, while she was running for election to U.S. House of Representatives, copies of her medical records were faxed anonymously to several newspapers, which ran them in front-page stories. It was never determined whether hospital personnel were responsible for the disclosure. Velazquez sued the hospital for breach of contractual and fiduciary duties of confidentiality, for wrongful disclosure, and for negligence in maintenance of the security of her medical records. Needless to say she won the lawsuit.

Research in the Journal of the American Medical Association found examples of web gossip by trainee doctors sharing private patient stories and details. Over half of 78 US medical schools studied had reported cases of students posting unprofessional content online through social networking sites like Facebook and Twitter. Many postings included profanity and discriminatory language. Many blog postings contained sexually suggestive material and photos showing drunkenness or illicit drug use. In this context it's pretty clear why patients would want their data to remain confidential.

Thank You!