Let’s respect patient’s confidentiality
By Dr Brighton Chireka
Once again patients’ confidentiality continues to be breached. There is no day these days that passes by without hearing about someone being named and shamed. This culture of exposing each other has gone further and now we are bombarded with pictures of patients in hospitals. One wonders how these pictures are taken and why and how are they finding their way into the public domain. Patients trust health professionals to keep their medical notes private and not public. I do not want to be a judge but would like to raise awareness so that whoever is doing that whether it’s a health professional, a friend or relative of the patient , to stop it.
In my field we have the “father of modern medicine” called Hippocrates. Hippocrates was a Greek philosopher and physician who lived from 460 to 377 BC. His work included the Hippocratic Oath which described the basic ethics of medical practice and laid down a moral code of conduct for doctors. That code still holds even today although it has been updated to take into consideration the modern way of life.
Many people think that doctors still swear the Hippocratic Oath. It is not compulsory but, in fact, many medical schools now hold a ceremony where graduating doctors do swear an updated version. The British Medical Association has drafted a new Hippocratic Oath on behalf of the World Medical Association. The General Medical Council (registration body for doctors in UK) also reissued its professional code and published a document on the ‘core values’ of medical practice which is followed by all the doctors in the UK.
Some of the promises in the classic Hippocratic Oath are:
to do good or avoid evil or do no harm towards patients
not to seduce patients
TO MAINTAIN CONFIDENTIALITY AND NEVER TO GOSSIP (emphasis mine)
I am going to address the promise to maintain confidentiality and to never gossip. It is central to the trust between health professionals and patients. Patients must have confidence in their health professionals. Without assurance on confidentiality, patients may be reluctant to seek medical attention or give doctors the information they need in order to provide good care.
The Department of health (DOH) in UK states the following about confidentiality:
“Confidentiality is an obligation for all staff. Staff should note that they are bound by the Confidentiality: NHS Code of Practice 2003. There is a Confidentiality clause in their contract and that they are expected to participate in induction, training and awareness raising sessions carried out to inform and update staff on confidentiality issues. Any breach of confidentiality, inappropriate use of health or staff records, or abuse of computer systems is a disciplinary offence, which could result in dismissal or termination of employment contract, and must be reported.”
The Nurse and Midwife Council (NMC) UK in its code, states that nurses and midwives must “uphold the reputation of your profession at all times” (NMC 2008), while students must “uphold the reputation of your chosen profession at all times” (NMC 2009a). Nurses and midwives will put their registration at risk, and students may jeopardise their ability to join our register, if they breach patients’ confidentiality.
Situations where patients’ confidentiality is breached.
There are very few health professionals who deliberately breach patients’ confidentiality. But patient confidentiality can be unintentionally breached very easily and the following are common situations where it happens:
Lifts and Canteens: Discussing of patient information by health professionals in, small, or crowded places always carries a risk. Caution needs to be taken whenever the health professionals discuss confidential information. This information can fall into wrong hands and the next minute it will be on social media.
A&E departments and Wards: These are areas where there may be many people, especially relatives and friends, who are in close proximity to health-care professionals discussing information about a patient. The patient may not be willing to share the medical information with friends or relatives but they will end up knowing due to the mistakes of the medical professionals.
Patient Notes: These are often left in an area with open access, e.g. on the receptionist’s desk where other patients and visitors can see them.
Computers, faxes, and Printers:
It is very common for patients to see personal information about other patients on faxes or print-outs which have not been filed away promptly. Additionally, when healthcare professionals are sending sensitive information via a fax machine or printer, they must ensure that the receiving machine is in a secure place where only those authorised can have access to them.
An even more frequent scenario is when, during the course of a clinic or during the course of a ward round, a computer screen bearing a previous patients details becomes visible to the next patient to be seen.
As a doctor I am duty bound to respect patients’ right to privacy and confidentiality. Our registration boards make it clear that patients have a right to expect that information about them will be held in confidence by their doctors.
I can only disclose patients’ information if I am given the consent by the patient or if it is required by law or it is in the public interest. I have to justify my actions as I can be sued by the patient for breaching confidentiality and my registration will be at risk if I am found guilty. As a doctor I must establish with the patient what information they want to share, who with, and in what circumstances.
Many people especially the Zimbabwean Diaspora think that just because they are paying the hospital bills for a person in Zimbabwe it gives them full access to the patient’s medical information. The patient has a right to withhold their medical information and the doctor must get consent from the patient before speaking to a relative or a sponsor. I personally get requests from relatives in the UK asking me to speak to doctors in Zimbabwe on their behalf. What these relatives forget is that the consent must come from the patient who must inform their doctor before any stranger can call asking for information. Phone calls are not safe as anyone can call and pretend to be somebody and get information they are not supposed to get.
We all know what happened to the Duchess of Cambridge, Kate Middleton, when she was in King Edward VII Hospital in London in 2012. The hospital where the Duchess of Cambridge was being treated for severe pregnancy sickness in December 2012 admitted it breached patient confidentiality after falling victim to a hoax call from an Australian radio station. The pranksters from Sydney-based 2Day FM managed to speak to the Duchess’s nurse who went on to reveal confidential information. The pressure of breaching confidentiality was so much that the nurse Jacintha Saldanha, 46, who took the call, which led to headlines around the world, killed herself three days later. This shows how serious the issue of patient confidentiality can be if not handled properly.
As a doctor if anyone close to the patient wants to discuss their concerns about a patient’s health, I have to make it clear to them that, while it is not a breach of confidentiality to listen to their concerns, I cannot guarantee that I will not tell the patient about the conversation. A doctor should not refuse to listen to a patient’s partner, carers or others on the basis of confidentiality. Their views or the information they provide might be helpful in the care of the patient. The difficult part for the doctor is to only listen without commenting in a way that will reveal medical information of the patient especially when the patient has asked the doctor not to reveal the medical information to anyone and also not to listen to particular people.
It is good practice to have a good relationship between the doctor and the patient as well as the relatives. Patients’ wishes must be respected and families must get organised and agree with the patient to appoint one person who will be the point of contact between the doctor and the family. The patient must decide the information that he/she wants to be shared with family members. The family and friends should respect the wishes of the patient and must not cause further distress to the patient.
Family members must realise that doctors are busy and look after other patients and cannot be expected to update the family every hour unless it is clinically necessary. Family members must also respect family secrets and must stop washing their dirty linen in public or try to score each other for old disputes by mocking the sick person in public. Remember that we will all fall sick one day and we will expect our privacy to be respected. We will not like the taste of our own medicine, so if we cannot take it why then give it to others?
Members of the public do cause a lot of distress to patients by acting as doctors in the streets. We know a lot of “doctors” that have never reached the medical school yet they roam our streets, diagnosing people. In their wisdom or lack of it these street doctors tell us that every thin person has AIDS and everyone taking tablets must be taking Anti-retroviral tablets. These street doctors also claim to be connected to certain real doctors and nurses in the hospitals who are supplying them with the diagnoses of patients admitted in hospitals. We have seen the media also publishing pictures of patients in hospitals and their unconfirmed diagnoses without getting permission from the patient concerned. This behaviour must stop and, if it is true but I doubt it, that some nurses and doctors are breaching patient confidentiality then they must be struck off the medical register as they are bringing the health profession into disrepute.
As a patient, it is your choice to either publicise your health information or not and you also choose the time and place to do so. No pressure or intimidation should be put on the patient by the public to reveal one’s medical information. Doctors are trained in medical ethics and know which medical information to make public in the interest of the public and also patients at times are willing to make their information public if it’s going to benefit the public. Lastly but not least remember that a doctor’s duty of confidentiality continues even after a patient has died so do not be offended if a doctor cannot reveal a lot of medical information about the deceased.
I hope that we will all play our part as a society in respecting each other’s confidentiality with regard to our health. As for health professionals, do not let your hard work and years of sleepless nights studying for your medical degrees be put to waste just because you cannot control your mouth. Surely, we cannot allow gossip to destroy the fruit of our sweat. Please let’s pause and think before we join in these bandwagons on social media revealing people’s medical information. Members of the public be warned as well as you will be sued and remember ignorance is no defence.
This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. You can contact him at: firstname.lastname@example.org or read more of his article on his blog DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr. Chireka has used all reasonable care in compiling the information, but makes no warranty as to its accuracy. Consult a doctor or other health care professionals for diagnosis and treatment of medical conditions.