Confidentiality

Firyal A. Al-Balushi Oman Medical College, MD4 Family Medicine Rotation

Outline of the presentation

Confidentiality:
Definition Importance Breaking confidentiality
Why and When Principles for disclosure

Legal consideration

Medical Confidentiality - Definition

- The right of an individual patient to have personal, identifiable
medical information kept private and undisclosed - Privileged communication intended only for the knowledge of a particular person - Children, adults, elderly, mentally disabled and the dead all

have the same right to confidentiality

 What is the importance of confidentiality?

Medical Confidentiality- Importance

1)
2) 3) 4) 5) 6)

Natural human desire due to fear of social embarrassment or disapproval or the fear of discrimination, stigmatization Protects from information misuse against patient Builds confidence and open communication Respects patients privacy, dignity and individuality Demonstrates doctors fidelity to the patient Encourages free exchange of information which is critical for effective medical intervention, public health effort, and preventing harm to others

Breaching Confidentiality
- Medical confidentiality is not absolute - Confidentiality can be breached in exceptional cases and with appropriate justification after patients approval
If you decide to disclose confidential information, you must be prepared to explain and justify your decision.

- Before breaching confidentiality think of: - Patients consent - Benefit of patient - Prevent harm to others - Law - Benefit for others: medical research

What Do you Think?

A. Patient confidentiality can be legally breached to the family if the patient has HIV ( T/F) B. Only medical information is held in strict confidentialitynot the patients personal life (T/F) C. Confidentiality of minors may be ethically breached when parents need to be informed of treatment or serious illness (T/F) D. Employment company representatives are privileged to certain medical information without consent from the patient (T/F)

Breaching Confidentiality
With the patients consent, Justifiable situations: Emergencies: To prevent a threat to the life or health of individual Statutory Requirement Public Interest Public Health
Reporting notifiable diseases

Required by Court or Tribunal Adverse Drug Reactions Complaints

Think..Benefit/Harm
-What is the Public Interest? -What about sharing information about uncommon incidences/practices? -How much information should be disclosed? Name, age, residence..etc

Caldicott Principles for Disclosure

There are 6 principles: 1. Justify the purpose 2. Do not use personally identifiable information unless it is absolutely necessary 3. Use the minimum personally identifiable information 4. Access to personally identifiable information should be on a strict need to know basis 5. Everyone should be aware of their responsibilities 6. Understand and comply with the law

Caldicott Principles for Disclosure

There are 6 principles: 1. Justify the purpose - Patient must have realistic opportunity to accept or refuse - Implied consent: when patient is aware about their information being shared but makes no objection - Document in the approval or decline BUT.. What if:
Child? Mentally incapacitated adult? Unconscious patient? A dead person (deceased)?

Caldicott Principles for Disclosure

2. Do not use personally identifiable information unless it is absolutely necessary 3. Use the minimum personally identifiable information 4. Access to personally identifiable information should be on a strict need to know basis 5. Everyone should be aware of their responsibilities
2. Action should be taken to ensure that those handling personally identifiable information are aware of their responsibilities and obligations to respect patient/client confidentiality. Every use of personally identifiable information must be lawful. Someone in each organisation should be responsible for ensuring that the organisation complies with legal requirements.

6. Understand and comply with the law

2.

Legal Consideration

Legal Consideration-OMAN
Rules & Regulations to Practice of medicine and Dentistry in Sultanate of Oman , 22/1996 : The doctor should not disclose patient confidentiality unless he obtains the consent of the concerned person. He may disclose it to a close relative such as parents adult son either for the seriousness of the patient ailment, or any other justified reason, he may also disclose it for the sake of preventing or uncovering a crime, or if he suspects that the patient is suffering from any of the stipulated communicable diseases, he should notify the concerned authority either spontaneously or 45 upon its request. If the doctor is assigned by a life insurance company to assess the clients he should disclose the confidentiality to the company only.

Penalties:
[a] warning [b] suspension from the practice for a maximum period of one year. [c] cancellation of the license and registration.

Case 1
Your cousin was admitted to the emergency room during your shift at the hospital. He is in critical condition. Your mother is very concerned about him, but she has not been able to reach your aunt and uncle. You know about your cousins condition. Do you tell your mom?

Case 2
A baby is brought into the emergency room. It is obvious that the baby has been physically abused. There are cigarette burns, Wasem scars and bruises all over his body. The hospital is swarming with media. A reporter has asked you for details. What do you do?

Case 3
You see a co-worker at the supermarket. She wants to talk about a particularly difficult patient. She is being very specific, using the patients name and condition. She even goes as far as to say a nuisance this patient is because the patient is so demanding. What do you do?

 In summary , Information MUST be:

Held securely and confidentially Obtained fairly and efficiently Recorded accurately and reliably Used effectively and ethically Shared appropriately and lawfully

Thank you.