‘PATIENT CONFIDENTIALITY'

The Hippocratic Oath states ‘whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even apart therefrom, which ought not to be noised abroad, I will keep silence thereon, counting such things to be sacred secrets... I will respect the secrets which are confided in me, even after the patient has died’.

Clearly confidentiality has, since centuries, the time of Hippocrates, played an important role in maintaining doctor-patient relationship. It is important that the clinician accept the responsibilities and understand the potential abuses in that relationship.

CASE

Mr. M, a 59-year-old Malay Man was presented to the Sungai Buloh Health Clinic (KKSB) with the complaint of seizure on a day before. The patient mentioned that before he had the seizure, he was sitting on the floor of his house watching television when he felt an aura. He however could not recall anything after that. 

Meanwhile according to his wife who witnessed the situation, the patient became quiet with upward gazed eyes at first. She also noticed that her husband started to have jerky movement for about 5 minutes. The patient became tired right after that but his wife claimed that he did not loss his consciousness and no foamy saliva drool out of his mouth. Later, the patient became demented and aggressive. Though his family tried to calm his down, he assaulted them and ran out of his house. His family managed to get him home without having any harm on both patient and his family members. The patient denied of urinary or bowel incontinence, head trauma, nausea, vomiting, fever, chest pain and shortness of breath. 

Later he came to the clinic for several times within a week or two and kept on asking for a medical certificate. Each visit the patient complained on the same illness, his epilepsy. The doctor advised him to go to HKL for a proper treatment since his frequent epilepsy may eventually lead to neurological deterioration. The patient later refused and said that he would be fine after a rest. However he came back several times later with the same reason and this lead to the doctor suspicion on the patient’s real condition. According to his report from HKL, the patient is stable for the past two years though he still has his follow-up till now. 

Two weeks later, the patient came to the clinic with the same presenting complaint and again refused to go to the HKL. The patient asked for another MC as he was unable to work.He was given the MC after the doctor questioned him on his regular absence on working and whether he is qualified for the MC.The doctor then diagnosed him with pseudoseizure and malingering as she mentioned the case to a nurse and some other patients.

Based on the case report above, the important ethical-medical issue that was not obviously mentioned in the report is disclosing the patient’s case to others. The doctor mentioned and complained about the patient to other nurses as well patients revealing the patient’s secrecy. It happened when prescribing a medical certificate repeatedly comes as an issue. Who has the right in disclosing patient confidentiality, to whom and in what situation? Basically, what is patient confidentiality?