‘PATIENT CONFIDENTIALITY' part 3

 

Consequences of disclosing patient confidentiality

Disclosing patient’s confidentiality can have a number of consequences to the patient, to the health care provider such as doctor or nurse, and also to the health care institution. 

For the patient, without an assurance that confidentiality will be maintained, patient might be less willing to disclose information, resulting in obstacles to their effective care. It may be not a disastrous for this case, where Mr. M only had seizure secondary to stroke, but if patient involved is a mental illness patient who needs special concern for privacy, he/she will suffer because of stigma, shame, feeling of failure, and possible detrimental effects if their mental and emotional conditions were to be known. Loss of employment, public embarrassment, disrupted relationships, and loss of insurability are among the potential consequences that people fear. Even worse if the disclosure affects the course of psychotherapy, where complete open-ness and honesty are vital to the treatment process. For these reason, patient clearly must aware that the ethics of the profession prohibit the practitioner from disclosing any information obtained through the physician-patient relationship.

For the health care provider, disciplinary action can be taken by the employer of the health care provider who made the disclosure, such as the hospital director. This is because an action for damage can be taken by patient not only against the person who made the disclosure but the employer also can be charge. Besides, the person who made the disclosure will be put in disciplinary proceeding under the health professional’s regulatory statute. That is why doctors should be aware of the basic principles of confidentiality and the ethical and legal framework around which they are built. Despite this frightening condition, ethical duty of confidentiality is not absolute^. Legal or statutory requirements sometimes override the limit of patient-doctor confidentiality ^. However patient’s consent should be taken first. If it is not possible to take patient’s consent due to certain condition, patient at least has to be told about the disclosure of their confidentiality.

               

                For the health care institution, once patient unwilling to disclose their history of illness because of no assurance in confidentiality, their treatment will be affected. This will give negative effects for their health, for public health and for health and social care practice. Imagine what will happen if failure of obtaining enough history of illness made the health care provider unable to diagnose an infectious disease that eventually spread to others. The health care that treats the patient will have to bear responsibility for these consequences.

                

 Due to these reasons yet other minor reasons as well, it is very important for both doctor and patient to understand well the principles of confidentiality to prevent unwanted consequences that will eventually discredit health care institution.

‘PATIENT CONFIDENTIALITY' part 2

  Patient Confidentiality and the Importance of Protecting It

As mentioned before, when a patient entrusted his/her health to a health care provider, the patient is not just asking for treatment or cure, he/she is also expecting for someone to talk to. Therefore, during the course of treatment or a consultation, a patient will reveal number of information regardless the relevance on his/her presenting complaint. All of this gained information either written or verbally are confidential and that means no clinician has the right to divulge those information to another person without the agreement of the patient.

The importance of confidentiality in health care are based on principles such as the respect for patient autonomy, consequentialist, implied promise and obviously virtue ethics. 

The respect for patient autonomy principle emphasizes the patient’s right to have control his/her life. It implies that a person has the right mostly to decide who should access to personal information about himself and this every individual’s right is applicable in other disciplines beside medicine. Undoubtedly, in the above case, the patient did not give his permission in revealing his details to other staffs, let alone to other patients

Every action has consequences. In the principle of consequentialist, the seriousness of breaching the confidentiality depends on the aftermath of the action. Let's say that for whatever reason, the patient eventually discovers that his doctor has breached the confidentiality, this will lead to numerous consequences.  The patient is upset; he loses trust in that doctor plus other health care providers and later becomes reluctant to seek any other medical practitioners resulting in his health deterioration.

A doctor-patient relationship is reflecting an implied contract or promise between two individuals. Patients decided to share their thoughts, feelings and sometimes reveal their secrets are actually another responsibility to a health care provider.  Though most of these promises are not written, all patient are expecting that their doctors to treat information confidentially.  As for Mr M’s case, besides revealing the information to others, it seemed like it has been another issue or gossip of a day. 

Virtue ethics is another principle of the importance of patient confidentiality. As a health care provider, showing empathy, good attitude, professionalism and respect to others are the acclaimed manners for centuries. It is not just the medications, indeed the kind of soothing virtuous manners that helps patients in some way. Once the particular doctor revealed other patient’s information to another patient, the doctor is in fact conveying a dreadful impression of a clinician.  Author has experienced the circumstance as well when a general practitioner disclosed another patient’s story and though it was undeniably enjoyable, eventually causing disrespect and loss of trust.

‘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?