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.
So the concept of confidentiality
goes back centuries.
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.
When they learn confidential information about a patient,
they should keep it secret and not spread it out.
So let's talk a little bit
about what confidentiality is.
It is an obligation to protect information
obtained about a person, obtained in confidence.
That's how we get the term
confidentiality or obtained in secret.
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.
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.
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.
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.
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.
And when the patient grants access, they're exercising
their right, they're not waiving their right.
They still have to have their right
to privacy upheld and protected.
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.
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.
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.
It starts with respect
So, this is an autonomous action by the patient that
they have the right to control access to themselves.
That's a matter of their
It also means that they
have to consent, you know,
so respecting autonomy means we're getting
the patient's permission to do things.
So if there is any need to disclose information that
we've learned that the patient consents to that.
There is the ethical
principle of beneficence.
So, sharing the sensitive information
truthfully is actually helping the patient.
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.
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.
And it also means that, you know,
you need to have this trust.
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.
If they're really concerned about their privacy, maybe they're
not going to be going to get the healthcare that they need.
And lastly, the ethical principle of
non-maleficence, so doing no harm.
So, when we disclose this personal
information, we may actually cause harm.
What are the harms?
Well, you could damage the
patient or family's reputation.
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.
It may interfere with
So again, partner has an affair, gets a sexually transmitted disease,
that gets out there that may damage their personal relationships.
It may be a threat to their employability,
their insurability or even their housing.
So there have been cases where people will be denied
insurance for having a pre-established condition.
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.
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.
So, very very important to make sure
we're protecting people's privacy.
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.
Often it's going to be
because of negligence.
They just have included enough safeguards
to keep the information secure.
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.
Maybe a family meeting room
where it can be more private.
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.
Nowadays, we also have to worry about social media.
So, maybe common for us.
As clinicians we need to sort of unwind
or debrief what's happened in our day.
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.
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.
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.
They can share private information about themselves, but we shouldn't be
reacting to private information because we have to protect that confidentiality.
So it's all very important to make sure we're being safe,
we're being secure in how we handle this information.