Where does the obligation of confidentiality come from?
Confidentiality is one of the basic tenets of medical practice and each day doctors face challenges to this long-standing obligation to keep all information between physician and patient private.
Patients share personal information with physicians and the doctor has a duty to respect the patient's trust and keep this information private. This requires the doctor 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.
What does confidentiality require?
It not only prohibits the physician from disclosing information about the patient's case to other interested parties but also encourages the physician to take precautions with the information to ensure that only authorized access is permitted. Yet the very act of medical practice does constrain this obligation to protect patient confidentiality as in the course of caring for patients, doctors exchange information about their 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. Computerised patient records pose new and unique challenges to confidentiality and prescribed procedures for computer access and security must be followed as an added measure to protect patient information.
What kinds of disclosure are inappropriate?
Inappropriate disclosure of information can occur in several clinical situations. Paucity of time may often lead to the temptation to discuss a patient in informal settings (cafeteria/staircase). Privacy of information exchanged in such settings is compromised, as it is difficult to keep others from over hearing. Similarly, information used for teaching purposes that contain identifiable patients should be removed as the patient's right to privacy is not being respected in these sorts of cases.
When can confidentiality be breached?
Confidentiality is not an absolute obligation and situations may arise where the harm in maintaining confidentiality is greater than the harm brought about by disclosing such information. In general, two such situations that may give rise to exceptions exist and in each situation, the doctor has to consider - will lack of this specific information about this patient put a specific person at high risk of serious harm? Legal regulations may exist that both protect and limit patient's right to privacy, noting specific exceptions to that right. These exceptions follow.
Concern for the safety of other specific persons Doctors have a duty to protect identifiable individuals from any serious threat of harm if they have information that could prevent the harm. Such breach of confidentiality is justified if there is good reason to believe specific individual(s) is/are placed in serious danger depending on the medical information at hand.
Concern for public welfare The most common example of this sort of exception is that of homicidal ideation, when the patient shares a specific plan with a physician or psychotherapist to harm a particular individual. This justifies breaking the traditional patient confidentiality.
Limited confidentiality exists when the doctor is required by law to report certain communicable/infectious diseases to the public health authorities. In these cases, the duty to protect public health outweighs the duty to maintain a patient's confidence. From a legal perspective, the State has an interest in protecting public health that outweighs individual liberties in certain cases. Local laws may vary regarding what is reportable and standards of evidence required.
What if a family member asks how the patient is doing?
While there may be instances where the doctor feels compelled to share information regarding the patient's health and prognosis with, for instance, the patient's inquiring spouse, without explicit permission from the patient it is generally unjustifiable to do so. Except in cases where the spouse is at specific risk of harm directly related to the diagnosis, it remains the patient's, rather than the physician's, obligation to inform the spouse.