There may be times when it's necessary to disclose
information that we've learned from a patient.
So there are 2 times when this might happen.
There is an implied consent and express consent.
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.
So, multiple people might need to take care of them,
sharing that information is to their benefit.
And we don't necessarily directly ask the patient for consent to that.
It's implied and patients understand that.
And when it's anonymized information
maybe for a clinical audit.
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.
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.
Expressed consent is necessary, you know, actually
getting the patient's permission in 3 main instances.
So, disclosure to the 3rd party.
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.
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.
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.
And then, release of identifiable
information for clinical research.
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.
Let's talk a little bit
more about implied consent.
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.
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.
But it really should be
on a right-to-know basis.
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.
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.
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.
So, that is a need-to-know basis,
they have to get that information.
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.
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.
Alright, when do we need expressed
consent by the patient?
So, we need to first of all do
an informed consent process.
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.
You'll also need to describe how much
information is going to be disclosed.
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.
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.
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.
So even if the patient says "No, I don't want you
to disclose it, it may be required by law to do so.
And it's going to depend
on the jurisdiction.
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.
It's a complex field.
You know, how we handle personal information
is going to vary from country to country,
state to state, jurisdiction
So you really need to know the laws in your
jurisdiction about how to handle private information.