MEDICAL CONFIDENTIALITY

Dr T Thirumoorthy SMA Centre for Medical Ethics and Professionalism September 13 2001

Medical Confidentiality
Respect for confidentiality is firmly established in codes of medical ethics 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

Medical confidentiality
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

Medical confidentiality
SMC Physicians Pledge I solemnly pledge to respect the secrets which are confided in me

Medical confidentiality - definitions 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 privileged communication intended only for the knowledge of a particular person confidential communication

Medical confidentiality - definitions Keep private information secret or undisclosed children, elderly, mentally disabled and the dead all have the same right to confidentiality

Medical confidentiality -why is it important natural human desire for privacy fear of social embarrassment or disapproval fear of discrimination, stigmatisation Information misused against patient

Medical confidentiality -why is it important builds confidence and open communication demonstrates doctors fidelity to the patient respects patients privacy, dignity and individuality

Medical confidentiality -why it is important

Encourages free exchange of information which is critical for effective medical intervention public health effort preventing harm to others

Medical confidentiality -importance

Medical confidentiality respects patient autonomy right to determine with whom, when and how much of personal medical information is shared

Medical confidentiality
when is it critical sexual history & STD adolescent sexuality alcohol & drug dependence psychiatric conditions marginalised persons

Medical confidentiality -principles of disclosure

Medical confidentiality is not absolute Disclosure to proper authorities- need to know not beyond what is required or relevent reason for disclosure documented in the medical records inform patient that such disclosure is required

Medical confidentiality - disclosure

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

Medical confidentiality

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

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

Medical confidentiality - 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

Medical confidentiality -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

Medical confidentiality -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

Medical confidentiality -disclosure for medical audit,

research,registeries approved by ethics committee ensure no harm to patient delink patients identifiable data registries operated under principle of medical confidentiality where feasible get consent or inform patient

Medical confidentiality - medical certificates Medical certificates for claiming benefits Patients and NOT doctors responsibility to pass the information Doctor hands the info to the patient marked Private & Confidential Correct diagnosis written after informing patient the possible implications

Medical confidentiality ethical dilemmas/special situations

Company/Managed care Occupational physicians Maids Employment examination Armed Forces Medical Officer Police & Prisons Doctor Electronics Medical Records

Medical confidentiality -a culture of professionalism Loose talk, corridor and lift gossip Doctors not to look at MR of patients not in their care Nurses, secretaries and attendants Conversation,MR, telephone &faxes Confidentiality consciousness

Medical Confidentiality -conclusions

All medical information that doctors acquire as part of the professional practice is subject to the Duty of Confidentiality Confidentiality is not absolute Disclosure should only occur with consent, for benefit of patient or with just grounds for disclosure