Introduction to Patient Confidentiality and Privacy

by Mark Hughes, MD, MA

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    00:00 In this lecture, we're going to talk about the very important topics of confidentiality and privacy and what we do with the information that we learned from patients.

    00:12 So the concept of confidentiality goes back centuries.

    00:15 So it's included in the Hippocratic Oath when it says "What I may see and hear in the course of treatment or even outside of treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful or unspeakable to be spoken about." So very clearly, it's been part of what a physician should do.

    00:39 When they learn confidential information about a patient, they should keep it secret and not spread it out.

    00:49 So let's talk a little bit about what confidentiality is.

    00:51 It is an obligation to protect information obtained about a person, obtained in confidence.

    00:57 That's how we get the term confidentiality or obtained in secret.

    01:03 It means that there is an expectation on the part of the patient that once they share this personal information with us and it's being done for their benefit, that the physician or clinician is going to protect that information.

    01:20 And that then when there is an expectation, entails that there is a promise within the context of that trusting relationship that the information will not be divulged without the patient's permission.

    01:34 Now, privacy is a larger concept, broader concept that isn't just between, you know, the clinician and the patient and the confidentiality that they have within their relationship.

    01:46 Now, we're talking about the philosophical notion of this is a basic human right, of liberty, freedom, where we don't want others to intrude on our lives, on our privacy.

    02:00 And so this idea of allowing access to our bodies or to information about us is a right to privacy that we're giving access but still the other person needs to protect and restrict information that they learned.

    02:22 And when the patient grants access, they're exercising their right, they're not waiving their right.

    02:27 They still have to have their right to privacy upheld and protected.

    02:34 Now, I see it as, you know, confidentiality is the focus on the relationship so it's really dependent on the trust that the patient places in the clinician to protect the information whereas privacy is really thinking about the information and protecting the information and it's because it's not just a single clinician that might have access to information nowadays.

    02:58 With electronic medical records with, you know, with multiple people on a healthcare team taking care of a patient, they have access to the information so it's important for all of them to be protecting that information.

    03:12 So, really thinking about in terms of the privacy. And why is it important? So, this is centered on ethical principles for why we need to respect confidentiality and privacy.

    03:25 It starts with respect for autonomy.

    03:27 So, this is an autonomous action by the patient that they have the right to control access to themselves.

    03:35 That's a matter of their being self-determining.

    03:39 It also means that they have to consent, you know, so respecting autonomy means we're getting the patient's permission to do things.

    03:46 So if there is any need to disclose information that we've learned that the patient consents to that.

    03:53 There is the ethical principle of beneficence.

    03:55 So, sharing the sensitive information truthfully is actually helping the patient.

    04:01 You know, if they are concerned that their information might be shared too broadly, they may not be so forthcoming, and that's going to interfere with us making an accurate diagnosis or figuring out the right treatment for them.

    04:14 So if they can share information truthfully, that's going to help them while we, you know, treat them, make a diagnosis, give them the treatment that they need.

    04:26 And it also means that, you know, you need to have this trust.

    04:28 So, when it is that one-on-one relationship between the patient and the clinician that that trust entailed by the confidentiality that we sworn to, if that warrant there are patients would not seek care.

    04:43 If they're really concerned about their privacy, maybe they're not going to be going to get the healthcare that they need.

    04:51 And lastly, the ethical principle of non-maleficence, so doing no harm.

    04:55 So, when we disclose this personal information, we may actually cause harm.

    05:00 What are the harms? Well, you could damage the patient or family's reputation.

    05:06 So if it's, you know, very sensitive information like having a sexually transmitted disease and that gets out in the world and, you know, this is going to damage the person's reputation, that is a harm to them.

    05:21 It may interfere with their relationships.

    05:24 So again, partner has an affair, gets a sexually transmitted disease, that gets out there that may damage their personal relationships.

    05:37 It may be a threat to their employability, their insurability or even their housing.

    05:41 So there have been cases where people will be denied insurance for having a pre-established condition.

    05:49 If this diagnosis were not, you know, in the medical record and weren't protected, then an insurance company could say "Well, I'm not going to cover you as an insured account for the insurance company." Or it might affect the patient's ability to get employment if they know that the patient has a particular condition.

    06:14 And at the root of this is going to be, you know, it creates mistrust of clinicians or the medical establishment as a whole if there are these breaches of confidentiality.

    06:24 So, very very important to make sure we're protecting people's privacy.

    06:29 So I think when there are breaches of confidentiality, it may not be so much malintent by the clinician that they, you know, are doing this intentionally to harm the patient.

    06:40 Often it's going to be because of negligence.

    06:42 They just have included enough safeguards to keep the information secure.

    06:48 So, examples of this could be how do you convey information either to the patient or to their family members you have to find a private space to do that.

    06:57 Maybe a family meeting room where it can be more private.

    07:02 If it's out in the hallway or in an elevator, waiting room, you know there's a potential that other people are going to overhear the conversation and then that obviously compromises the patient's privacy.

    07:16 Nowadays, we also have to worry about social media. So, maybe common for us.

    07:22 As clinicians we need to sort of unwind or debrief what's happened in our day.

    07:27 It might be inclination to maybe talk about, you know, a tough day you had a work of, you know, the patients you need to take care of.

    07:36 And maybe there's a, you know, general inclination to de-identify that information but even just posting about the patient description, what happened, any kind of testimonials about the patient or even, you know, photographs, even if it doesn't have any name attached to it that might be enough of identification that that is a breach of confidentiality.

    08:02 It's also nowadays happening that patients are posting reviews of us as clinicians and if we respond to those posts that might be a violation of their privacy where reacting to something that they put on the internet and that may be a problem if we are, you know, directly addressing those concerns because it's private information about them.

    08:26 They can share private information about themselves, but we shouldn't be reacting to private information because we have to protect that confidentiality.

    08:35 So it's all very important to make sure we're being safe, we're being secure in how we handle this information.

    About the Lecture

    The lecture Introduction to Patient Confidentiality and Privacy by Mark Hughes, MD, MA is from the course Patient Confidentiality and Privacy.

    Included Quiz Questions

    1. Obligation to protect information obtained in confidence
    2. Desire to protect information obtained in confidence
    3. Obligation to reveal information obtained in confidence
    4. Obligation to reveal information obtained in a clinic
    5. Duty to reveal information obtained in a hospital
    1. Autonomy
    2. Veracity
    3. Accountability
    4. Fidelity
    5. Justice
    1. Delay in the physician hiring process
    2. Damage to reputation
    3. Threat to employment
    4. Threat to housing
    5. Damage of trust
    1. Discussing health information in a family meeting room
    2. Discussing health information in the waiting room
    3. Posting a health record photograph on social media
    4. Responding to personal reviews
    5. Discussing health information in the elevator

    Author of lecture Introduction to Patient Confidentiality and Privacy

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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