Disclosure of Patient Information

00:00 There may be times when it's necessary to disclose information that we've learned from a patient.

00:08 So there are 2 times when this might happen. There is an implied consent and express consent.

00:13 So, we generally assume that a patient, you know, understands that sharing of information within the healthcare team is going to provide them the best care possible.

00:24 So, multiple people might need to take care of them, sharing that information is to their benefit.

00:31 And we don't necessarily directly ask the patient for consent to that. It's implied and patients understand that.

00:39 And when it's anonymized information maybe for a clinical audit.

00:43 So, as I've mentioned, the hospitals might need to do quality improvement projects, they want to see how they're doing in delivering their care.

00:50 If it's de-identified or anonymized, you take out the particulars of the patient information but have all their clinical data, that is also, you know, assumed to be implied consent. Patients would be agreeable to that.

01:08 Expressed consent is necessary, you know, actually getting the patient's permission in 3 main instances.

01:15 So, disclosure to the 3rd party.

01:17 So, the patient usually requires, you know, signature on a form that's saying "Yes, you can disclose this to the insurance company for billing purposes." If it's released for clinical audit and it has identifiable information.

01:34 So again maybe something like risk management at a hospital, they need to investigate if a medical error has occurred, they need the particulars of the case.

01:43 There, you might need to get the patient's permission to release that for the clinical audit or for billing purposes would be the other example.

01:53 And then, release of identifiable information for clinical research.

01:57 We'll have another lecture, you know, on clinical research in general but generally we want to get informed consent when we're performing clinical research especially on identifiable information about a patient, so getting their permission as a research participant.

02:14 Let's talk a little bit more about implied consent.

02:16 So as I said, medicine nowadays is team-based and it's crucial for patient safety as well as continuity of care that the other team members have access to information.

02:31 It should be understood that the information is being disclosed for the patient's benefit for these other healthcare professionals to deliver the care that they need to do to fulfill their roles and responsibilities.

02:43 But it really should be on a right-to-know basis.

02:47 The patients may ask "Well, I don't want certain information to be disclosed to another team member." They have to right to withhold certain amounts of information.

02:57 The only exception to this would be if the withholding of information, if that non-disclosure would actually place others at risk of death or serious harm.

03:07 So, let's say it's a patient with a contagious disease and, you know, they're diagnosed with tuberculosis and they say "Well, you know I don't want this shared with other members of the team." Well, the next person that has to take care of them needs to know that they need to take respiratory precautions to prevent themselves from getting tuberculosis.

03:28 So, that is a need-to-know basis, they have to get that information.

03:32 The patient can actually, you know, say "Withhold it." There's also the sharing of information within the team should be on a need-to-know basis.

03:42 So, what's the role of the member of the team? What's the role of the member of the staff? What are they needing to know about the patient? And then, you know, maybe only get certain amount of information to fulfill their role and responsibilities.

04:02 Alright, when do we need expressed consent by the patient? So, we need to first of all do an informed consent process.

04:09 So patients need to understand given enough information about why we need to disclose the information, the reasons for the disclosure, and what are the likely consequences of the disclosure? What are the risk and benefits as it were? So, hopefully you're going to be disclosing it for the benefits of the patient but there might also be risk or someone else got access to this information.

04:33 You'll also need to describe how much information is going to be disclosed.

04:36 Is it just a summary? Is it just test results? Is it the actual medical record? What amount of information is disclosed and who is going to receive it? So, generally if we're doing, you know, providing continuity of care, if a patient comes to me and I'm a primary care physician and I send them to a specialist, I'm going to send the medical records to the specialist but I want to get the patient's permission to do that to send that to the next physician.

05:05 And if the patient withholds consent, so we said, you know, the right to both refuse and to consent when we're doing informed consent or you're not able to obtain consent for whatever reason, it needs to be made clear that there are going to be times where disclosures are necessary if they're required by law or can be justified in the patient's interest or in the public's interest.

05:30 So again, something like the patient with a contagious disease, maybe they say, you know, they don't want this information disclosed but for public health reasons it needs to be disclosed, you need to report that to the health department so that there could be quarantining, you could identify any people that might have had exposure to the patient that might be at risk of contracting that contagious disease.

05:53 So even if the patient says "No, I don't want you to disclose it, it may be required by law to do so.

05:58 And it's going to depend on the jurisdiction.

06:01 So, when we talked about the interface between ethics and law, you try to adhere to what the law says, you must comply with the law when it's either using, accessing, or disclosing this personal information.

06:16 It's a complex field.

06:18 You know, how we handle personal information is going to vary from country to country, state to state, jurisdiction to jurisdiction.

06:27 So you really need to know the laws in your jurisdiction about how to handle private information.