Confidentiality in the Workplace Flashcards
What is confidentiality?
Patients have a right to expect that information about them will be held in confidence by their doctors, inc after a patient has died
Why is confidentiality important from an ethical perspective? What are the considerations?
- Part of patient autonomy
- Beneficence
- Virtuous behaviour
- Trust and developing rapport
- Privacy rights (respect of privacy)
- Consequentialist justifications
Why is confidentiality becoming a more significant issue?
Due to proliferation of electronic medical records and other technologies
Increased use of social media as well as awareness of patient’s rights
Who can access a patient’s confidential information?
Clinical staff and students, administrative staff, social workers et al.
About 50 personnel have access to notes
NOTE: Not pragmatic to consent every patient for access
What does the COMMON LAW vs STATUTE LAW say on breaking confidentiality?
Common law: Balance public interest in doctors keeping confidentiality, with protecting others from harm
Statute law: Human Rights Act 1998 indicates balance between right to privacy, life and freedom of speech
Common law > Statute law
What is the professional basis of confidentiality (NHS)?
- Must disclose if required by law; tell patient if practicable but no consent required
- Must disclose if ordered by judge but can object if information wanted is irrelevant
What are justifiable breaches of confidence?
- Research (anonymised data)
- Protection of patient
- Protection of others
- Detection and prosecution of serious crime
- Legal purposes – e.g. defence of a legal claim
- Statistical purposes/obligation to disclose
When can disclosure be done without patient’s consent?
- Justifiable disclosure in the public interest (ie there must be a serious risk of harm) AND one of the following:
- Not competent to consent
- Obtaining consent would put others at risk
- Obtaining consent would undermine the purpose
- Time is of the essence
Disclosure must be made only to those who are in vital need of the information
Statutory requirements to break confidentiality?
- Notification of births, stillbirths, deaths, fertility treatments, termination of pregnancies
- Communicable diseases
- Drug addicts, poisonings, serious work accidents
- Terrorism, court orders under the Police and Criminal Evidence Act (1984)
What are the practical issues of breaching confidentiality?
- Consultation with GMC, indemnity organisation, or Clinical Ethical Committee
- Also consulting colleagues and seniors
- Final decision lies with healthcare team – good proof of process shows deliberation
Explain how confidentiality can tie in with genetic conditions
Genetic conditions – consideration of harm, family and life planning, potential benefits in early treatment
Disclosing info: psychological harm. Consideration of whether genetic information can be shared publicly, with family or owned by individuals
Explain how confidentiality can tie in with a patient’s impairment of driving
DVLA – consideration of severity of condition and whether it poses a specific threat to an identifiable individual
GMC guidelines – Dr’s responsibility to inform patient of importance of DVLA disclosure, understanding of condition, and every effort to persuade patient to voluntarily inform DVLA before submitting in writing
Explain how confidentiality can tie in with criminal issues
Criminal issues – murder, rape, terrorism and other violent crimes, road traffic accidents
Blood alcohol should not be disclosed by clinicians- duty of the police to perform such tests
Tests and procedures should only be done with clinical indications
