130507L - RELEASE OF CONFIDENTIAL INFORMATION

Lecture for 4^th year medical students Salman bin Abdulaziz University Kharj on May 7, 2013 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard)

1.0 RELEASE OF INFORMATION BY THE PATIENT

The injunction to keep secrets is binding on both the caregiver and the patient. The patient should not make unnecessary revelation of negative things about himself or herself. The patient should consider any injurious information as a secret not to be revealed. It is forbidden to reveal sins instead the person should repent, seek forgiveness, and never return to the sin. The development of extensive genetic screening technologies has resulted into restrictions on the patient disclosing his or her own medical information. Disclosure of a genetic defect by a patient also discloses information about genetic defects in parents and siblings.

 

2.0 RELEASE OF THE INFORMATION BY THE CAREGIVER

The caregiver should cultivate the habit of saying only good words and avoiding bad ones. He should also cultivate the habit of being humble and speaking little. Speaking too often and to anybody may unconsciously lead to divulging confidential information.

The general position of the Law is that a caregiver cannot divulge any information about a patient without the patient’s consent or in exceptional circumstances defined by the Law such as when an infectious disease has to be reported.

It is prohibited for the caregiver to use the privileged medical information he has for any personal gain. For example, he cannot use his knowledge of the health of a businessperson to buy shares in a certain company. He cannot advise his relatives about marrying or not marrying a certain person because of what he knows about their health.

Release of information in the public interest is a more complicated situation. The question arises whether a caregiver is obliged to reveal disease in a leader or airline pilot that could endanger the public? What should the caregiver do if he knows of a patient with a contagious disease that is in the community and is endangering others? Is it a violation of privacy for the caregiver to share medical information with other caregivers caring for the same patient? What about using the data for medical research or medical education? How much can the caregiver tell the relatives of the patient without compromising the regulation of keeping secrets? What should the caregiver do if approached by law enforcement agencies asking for specific medical information that can help them solve a crime? Can a caregiver testify in court against his patient using information obtained during the medical examination? All these are questions for which no easy answers can be given most of the time. The simplest situation is when the patient, the owner of the records, consents to their release provided no other individual is directly hurt by such a release. The patient’s wishes to have information divulged to some individuals may have to be respected.

The rules of informed consent for treatment also apply to consenting to information release

3.0 JUSTIFIED INFORMATION RELEASE WITHOUT CONSENT

3.1 Release to other health care workers: Information has to be released to other health care givers in the process of clinical management. Consent in such a situation is implied and there is no need to seek any special consent from the patient.

3.2 Legal requirements and the Public Interest: Information release may be required by statute such as reporting notifiable diseases. In some situations public interest may necessitate information release. Information can be released in the public interest to protect the public from infection or from violence even if the patient withholds consent. Crime investigation may justify information release. Judicial proceedings may require release of information to ensure justice. In cases of court litigation, the caregiver could testify in criminal cases There are situations in which over-riding public interest will require refusing to release information even if the patient consents.

4.0 UNJUSTIFIED RELEASE OF INFORMATION WITHOUT CONSENT

4.1 Education, research, medical audit are not situations of necessity that justify violation of confidentiality. Information can be released only if the patient consents. Information release can be allowed if the information is anonymous or is an aggregated form such that no individual patient can be identified.

4.2 Employers or insurance companies may require medical information in order to make certain decisions. These are not considered situations of necessity that justify violation of confidentiality. There is no difference in the Law between disclosure during life or after death of the patient. One of the ways for the caregiver to decrease his risk of revealing secret information is to have only the minimum needed for his work. This means that during history taking only those questions directly related to the medical problem should be asked. There should be no probing or digging for unrelated facts.

4.3 Divided or conflicting loyalties

Some physicians find themselves in a situation of conflict and divided loyalty. A company physician is obliged to report to his employers that will violate the confidentiality between him and his patients. Military physicians may also have to report medical information to the higher brass. The physician may have to make a notification to relevant authorities when he believes that there is serious danger to third parties for example HIV positive cases who share needles or epileptic drivers. Parents who abuse their children may have to be reported. It may be necessary to notify a spouse in case of HIV infection.