Confidentiality Flashcards
What information would break confidentiality?
All information that can identify a patient
eg photograph, NHS number, full post code plus clinical info
What about sharing information with the clinical team?
This is taken as implicit consent to facilitate care
On a ‘need to know’ basis
Sharing info with social services usually needs explicit consent from competent patients
In patients that lack capacity, how does confidentiality work?
Their healthcare information may need to be shared with others to facilitate a decision (eg parents of children need to know diagnosis, prognosis, treatment options)
When can ‘confidential’ information be disclosed?
If:
- The patient consents to disclosure
- The disclosure is required by law (to regulatory bodies that have powers to access patient’s records
- It is justified in the public interest
What is disclosure in the public interest?
When ‘it is essential to prevent a serious and imminent threat to the public health, national security, the life of the individual or a third party or to prevent or detect serious crime’
eg a patient with a diagnosis that puts others at risk if he continues to drive
If a competent patient refuses to disclose information to help him/her do you respect that decision?
If you have tried persuading them and warned them of the risks of refusal
Only if non-disclosure leaves them, but nobody else, at risk of serious harm
If a competent young person (eg 17yrs old) admits to illicit drug use but doesn’t want her parents to know, should the parents be told?
Information should be disclosed if it is necessary to protect the child/young person, or somebody else, from risk of death or serious harm
eg If a child/young person is involved in joy-riding, serious addiction or self-harm
Would parents be able to stop the drug use? Is the degree of criminality and harm enough to justify disclosure to parents?
Should try to persuade the child to involve parents for important or life-changing decisions
What does the data protection act deal with? What does it state?
DPA deals with the use and handling of confidential information
Personal data shall be processed fairly and lawfully
Obtained only for one or more specified lawful purposes
Be adequate, relevant and not excessive
Be accurate and up-to-date
Not be kept for longer than necessary
Are patients allowed access to their medical records?
Yes they are entitled to view their own records
But the doctor has the responsibility to remove any information in the records that pertains to a third person
What confidentiality remains after death?
Duty of confidentiality remains after death
Certain circumstances allow the relevant information about the patient’s death to be disclosed:
-To help a coroner/procurator fiscal with an inquest/fatal accident inquiry
-On death certificates which must be completed honestly and fully
-When a parent asks for info about the circumstances and causes of a child’s death
-When a partner/close relative/friend asks for information about the circumstances of an adult’s death, and there is no reason to believe that the patient would have objected to such disclosure
-When a person has the right to access to records under the Access to Health Records Act 1990
When would disclosure of HIV status be justified?
To protect a person from risk of death or serious harm
Inform the patient before disclosure and try to persuade self disclosure
The patient must be informed that it may amount to ‘reckless’ transmission of HIV which is a criminal offence, resulting in prosecution. Also would allow informed decisions to be made and PeP to be offered
Cases would be discussed in an MDT with a timeline agreed for the patient to self disclose, after that time the clinic would step in and say ‘he has been at risk and needs HIV testing’
What are professional interpreters expected to do?
Act in an impartial and professional manner
Be fluent in the language specified
Not pretend to understand something when they have not
Interpret accurately without anything being omitted or added from the interaction
Why should you use a professional interpretation service?
Misinterpretation-> misdiagnosis/ sub optimal treatment
Consent may be invalid if pt doesn’t fully understand
Avoids patient confidentiality issues
Embarrassing or sensitive information can be said without relatives being present
What is the difference between genetic testing and genetic screening?
Genetic testing provide info about whether the person tested has a genetic mutation for a specific disease (eg Huntington’s)
Genetic screening identifies individuals who are carriers of specific genetic disorders and may not develop the disease but may pass the genes onto their children (eg cystic fibrosis)
What does the Joint Committee on Medical Genetics say about disclosure of genetic test results?
Pre test counselling should cover the fact that the genetic test results may have a significant impact for the other family members and therefore communication of certain aspects of info is recommended
A breech of confidentiality may be justified to avoid serious harm.
Sharing genetic information with relatives may enable them to get prophylaxis/preventative measures or make use of increased surveillance and prepare for potential health problems
May lead to morbidification (falling victim to inescapable fate through knowledge of an existing disease)
May also allow them to make informed choices about not having children/pre implant genetic diagnosis
