Confidentiality

medical ethics
Dr. Rami Abo Ali

1. Medical Ethics and Legal medicine Dr. Rami Abo Ali Medical Ethics - Dr. Rami Abo Ali 1

2. Confidentiality Medical Ethics - Dr. Rami Abo Ali 2

3. Privacy : A right or expectation to not be interfered with - Be free from surveillance - A moral right to be left alone. RESPECTS PATIENT’S BODY Confidentiality : Is the right of an individual to have personal, identifiable medical information kept out of reach of others . RESPECTS PATIENT’S INFORMATION 3 Medical Ethics - Dr. Rami Abo Ali

4. Measures to Protect Privacy Make sure examination takes place in isolation from other patients , unauthorized family members, and/or staff Provide gender-sensitive waiting and examination rooms Provide proper clothing for the admitted patients Make sure patients are well covered when transferred from one place to another in the hospital Make sure your patient’ s body is exposed ONLY as much as needed by the examination or investigation Patients should have separate lifts and be given priority 4 Medical Ethics - Dr. Rami Abo Ali

5. Measures to Protect Privacy Always take permission from the patient before examination Insure privacy when taking information from patients Avoid keeping patients for periods more than required by the procedure. It ’s prohibited to examine the patient in the corridors or in the waiting area . During examination, no foreign person unrelated to the patient allowed Give patients enough time to expose the part with pain Only relevant personnel are allowed to enter the examination room 5 Medical Ethics - Dr. Rami Abo Ali

6. Medical Secret Medical secret is defined as: “ Any medical information that comes to the knowledge of the practitioners as a result of their work whether directly obtained from the patient, or otherwise” 6 Medical Ethics - Dr. Rami Abo Ali

7. Medical Secret It includes any information that the doctor (or treatment team ) knows about the patient (alive or dead), directly or indirectly that a patient may deem its disclosure undesirable or harmful to his/her health , reputation, financial, social or professional status. It includes any information about the patient ’ s identity, condition , diagnosis, investigations’ results, treatment, and/or prognosis (whether chances of cure, disability, or death) 7 Medical Ethics - Dr. Rami Abo Ali

8. Privacy is valued in ethics and law Protecting someone’s privacy involves protecting them from unwanted access or control by others. In this way it is linked with personal autonomy and it is also viewed as a key element of personal identity. Privacy can be thought of in terms of five dimensions: Physical privacy Informational privacy Decisional privacy, Personal property Expressive privacy. 8 Medical Ethics - Dr. Rami Abo Ali

9. Physical privacy Protecting patients’ physical privacy will alert staff to : Introduce physical touch with request and explanation. Minimize the duration and the extent of exposure. Minimize or get permission for the bedside presence of medical/nursing students, spectators , or cameras producing photographs for study purposes Provide explanations to patients of what happens during times when they are unconscious The importance of expanding the number of single over shared hospital rooms The sensitivity of many patients to rooms of mixed sexes The possible preference of some patients for doctors or nurses of their own sex . 9 Medical Ethics - Dr. Rami Abo Ali

10. Informational Privacy Secrecy, confidentiality, anonymity and protection of patient data Decisional Privacy Patients can expect to be allowed, if not encouraged, to make their own decisions and act on their decisions if they so choose free from state, governmental or health professionals interference Concerns responsibility for very important choices about treatment, termination of treatment, and involvement in clinical trials 10 Medical Ethics - Dr. Rami Abo Ali

11. Personal Property Includes all of a patient’s personal belongings and, especially, those items that are considered by them to be most important, e.g., personal diaries, letters, handbags and wallets . Expressive Privacy Protects a region for expressing one’s self-identity or personhood through activity or speech. Self expression is critical for lifestyle choices that contribute greatly to defining oneself and one’s values. 11 Medical Ethics - Dr. Rami Abo Ali

12. What is Confidentiality? “ The ethical principle or legal right that a physician or other health professional will hold secret all information relating to a patient , unless the patient gives consent permitting disclosure ” “The nondisclosure of information except to another authorized person ”. 12 Medical Ethics - Dr. Rami Abo Ali

13. Why is there a Duty for Confidentiality? Trust between patients and health professionals . Patients give information about their health in confidence . Individuals will be encouraged to seek appropriate treatment and share information relevant to it. 13 Medical Ethics - Dr. Rami Abo Ali

14. Because it has long been held as an honored bond between health professionals and patients , the keeping of confidentiality has been enshrined in both professional and legal codes. It was first articulated in the Hippocratic Oath ( c.5Th Century BC): ‘What I may see or hear in the course of the treatment or even outside of the 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 to be spoken about.’ 14 Medical Ethics - Dr. Rami Abo Ali

15. Confidentiality is protected by professional codes and laws Ancient and modern medical and nursing codes stress the duty of confidentiality as a ‘time honored principle’ that extends beyond death . Health professionals are also legally obliged to protect patient confidentiality under the common law : legal sanctions are in place for breaches of patient confidence . 15 Medical Ethics - Dr. Rami Abo Ali

16. Confidentiality in the healthcare setting All information about one’s patient is confidential. This means not only their health situation but also, living situation, family , and finances. As part of the Health Insurance Portability and Accountability Act ( HIPAA ): healthcare organizations must make sure that patient’s medical information remain safe and confidential . 16 Medical Ethics - Dr. Rami Abo Ali

17. Health Insurance Portability and Accountability Act (HIPAA) The  Health Insurance Portability and Accountability Act  of 1996 ( HIPAA ) is a federal law  that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge Assures that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being . Applies to health plans, health care clearinghouses, and to any health care provider who transmits health information. Protects all individually identifiable health information held or transmitted by a covered entity or its business associate , in any form or media, whether electronic, paper , or oral . 17 Medical Ethics - Dr. Rami Abo Ali

18. Thing that Should be Kept Confidential Name Address Birth date Social Security Number Phone number Medical record number Diagnosis Treatment Prognosis 18 Medical Ethics - Dr. Rami Abo Ali

19. Confidentiality Measures Limit the accessibility to the medical records Do not discuss the patient’ s medical information with unauthorized family members Do not disclose patient’ s information without his/her consent , or in established exceptions Do NOT collect information not related to the provision of care Set policies that regulate access to medical information and how any breach to confidentiality is managed Limit sharing of information with other staff, unless in cases of consultations and second opinion 19 Medical Ethics - Dr. Rami Abo Ali

20. Confidentiality Measures In a ll records Never inappropriately access records; Shut/lock doors, offices and filing cabinets; Query the status of visitors/strangers ; In m anual records Hold in secure storage; Tracked if transferred, with a note of their current location within the filing system; Returned to the filing system as soon as possible after use; Stored closed when not in use so that the contents are not seen by others; Kept on site unless removal is essential. 20 Medical Ethics - Dr. Rami Abo Ali

21. Confidentiality Measures In e lectronic records Always log out of any computer system or application when work is finished; Do not leave a terminal unattended and logged in; Do not share Smartcards or passwords with others; Change passwords at regular intervals; Always clear the screen of a previous patient’ s information before seeing another. Email and fax Whenever possible, clinical details should be separated from demographic data; All data transmitted by email should be encrypted 21 Medical Ethics - Dr. Rami Abo Ali

22. Tips for Maintaining Confidentiality Only view information on patients that you are directly providing care to . After viewing confidential information on the computer, log off so others cannot view the information. Avoid discussing a patient’s care in non-private areas , e xamples : elevator, hallway or cafeteria. You never knows who is listening. 22 Medical Ethics - Dr. Rami Abo Ali

23. Tips for Maintaining Confidentiality Be careful of what you throw away. Personal health information should never be disposed of in the trash can . Any document thrown in the trash is open to the public and therefore a breach of information. Think before you speak. Is what you are about to say confidential? If so is the person you are speaking to part of the patient’s healthcare team? 23 Medical Ethics - Dr. Rami Abo Ali

24. If patients lack the capacity to consent to sharing information Health professionals may need to share information with relatives, friends in order to enable them to be involved in decisions about the patient’s best interests. The sensitivity of the information and any known wishes of the patient in regard to it must be taken into account. While hospitals may routinely seek the consent of the ‘next of kin ’ in relation to a decisions , this consent has no legal basis . 24 Medical Ethics - Dr. Rami Abo Ali

25. What if a family member asks how the patient is doing? While there may be cases where the physician feels naturally inclined to share information, such as responding to an inquiring spouse, the requirements for making an exception to confidentiality may not be met. If there is not explicit permission from the patient to share information with family member, it is generally not ethically justifiable to do so. Except in cases where the spouse is at specific risk of harm directly related to the diagnosis, it remains the patient's (and sometimes local public health officers’), rather than the physician's , obligation to inform the spouse. 25 Medical Ethics - Dr. Rami Abo Ali

26. Disciplinary Actions for breaching patient confidentiality Disciplinary actions for breaching patient confidentiality can range from fines to termination of employment , depending on the extent of the breach . Be aware that you can be held liable even if you give out your patients’ personal information by mistake . In June 2010 five California hospitals were issued administrative fines and penalties totaling $675,000 after it was determined they'd failed to prevent unauthorized access to confidential patient medical information. 26 Medical Ethics - Dr. Rami Abo Ali

27. Considering the disclosure You may disclose personal information if it is of overall benefit to a patient who lacks the capacity to consent . When making the decision about whether to disclose information about a patient who lacks capacity to consent, you must : make the care of the patient your first concern respect the patient’s dignity and privacy support and encourage the patient to be involved, as far as they want and are able, in decisions about disclosure of their personal information 27 Medical Ethics - Dr. Rami Abo Ali

28. The Five C's of Confidentiality and How to DEAL with Them Consent — A clinician may release confidential information with the consent of the patient or a legally authorized surrogate decision maker, such as a parent, guardian, or other surrogate designated by an advance medical directive. Court Order — A clinician may release confidential information upon the receipt of an order by a court of competent jurisdiction. Continued Treatment — A clinician may release confidential information necessary for the continued treatment of a patient. Comply with the Law — A clinician may reveal confidential information in order to comply with mandatory reporting statutes (e.g., child abuse), and other such lawful purposes. Communicate a Threat — This is the well known Tarasoff exception to confidentiality that involves the clinician's duty to protect others from violence by a patient. 28 Medical Ethics - Dr. Rami Abo Ali

29. Conditions to Disclose Medical Secret Approval from the patients within the limit given in the approval If the information are required by judiciary Consultation or second opinion. Notification of events of public health interest/threats ( birth, death, notifiable diseases, etc.) Prevent individual/personal threats (e.g. prevent crimes) If needed by the doctor to defend him/herself before judges , or discipline committee If the patient consciously and truly admits committing a crime on which another person was accused/punished Remember: Disclosure should be only to the concerned party & not beyond the needed limits 29 Medical Ethics - Dr. Rami Abo Ali

30. The duty of confidentiality extends beyond death Guidelines that protect living patients equally apply after patients have died. Exceptions to confidentiality also equally apply. International guidelines governing the release of medical records of deceased patients generally consider: the known wishes of deceased patients in relation to their information. the impact of non-disclosure on the wellbeing and welfare of third parties – avoiding harming them or benefitting them. the impact of disclosure on the reputation of the deceased; the possibility of anonymising the information . 30 Medical Ethics - Dr. Rami Abo Ali

31. Deceased Patients Your duty of confidentiality continues after a patient has died . Whether and what personal information may be disclosed after a patient’s death will depend on the circumstances. If the patient had asked for information to remain confidential, you should usually respect their wishes. If you are unaware of any instructions from the patient, when you are considering requests for information you should take into account: Whether the disclosure of information is likely to cause distress to, or be of benefit to, the patient’s partner or family Whether the disclosure will also disclose information about the patient’s family or anyone else Whether the information is already public knowledge or can be anonymised or coded, and The purpose of the disclosure’ 31 Medical Ethics - Dr. Rami Abo Ali

32. Case Your 36-year-old patient has just tested positive for HIV. He asks that you not inform his wife of the results and claims he is not ready to tell her yet. What is your role legally? What would you say to your patient? 32 Medical Ethics - Dr. Rami Abo Ali

33. Case Discussion Because the patient's wife is at serious risk for being infected with HIV, you have a duty to ensure that she knows of the risk. While public health law requires reporting both your patient and any known sexual partners to local health officers, it is generally advisable to encourage the patient to share this information with his wife on his own, giving him a bit more time if necessary.  33 Medical Ethics - Dr. Rami Abo Ali

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