I was reading an article in the Deccan Chronicle that a patient was photographed during delivery and put on the World Wide Web. I wish to ask many: Is it acceptable if the patient happens to be your near and dear one?
The great lesson, my highly qualified surgeon Dr R S Kulkarni taught was that never do a physical examination of a female patient whatever the age without a female attendant. Never forget that so many famous doctors went into trouble violating the modesty of a female patient. With upraise of technology any one can photograph, steal the patient’s electronic information. Today, it is an issue with advances in smartphone, 3G and broadband technology.
Respect for the confidentiality of patients’ information is a basic principle of ethical and effective medical practice. It ensures individual patient’s privacy and, more broadly, it upholds public perception of the quality of the healthcare system and its professionals. Never forget that great institutes can lose the business with trivial litigations when basic principles of privacy are violated.
I wish to clarify on privacy and confidentiality, challenges of maintaining privacy and confidentiality. It’s not easy to know the difference between privacy and confidentiality, it can be confusing.
Privacy is the right of individuals to keep information about themselves from being disclosed; that is, people (our patients) are in control of others access to themselves or information about themselves. Patients decide with whom, when, and where to share their health information. Taking the example of HIV infection he or she can discuss the problem with their kin; none of us have any right to discuss the matter beyond post-test counselling.
On the other hand, confidentiality is how we as doctors, and nurses, treat private information once it has been disclosed to others or ourselves. This disclosure of information usually results from a relationship of trust; it assumes that health information is given with the expectation that it will not be divulged except in ways that have been previously agreed upon, e.g. for treatment, for payment of services, or for use in monitoring the quality of care that is being delivered.
With the increasing use of technology for the provision of care in our fast-paced clinical environments, maintaining privacy and confidentiality can be a daunting task; many have the habit of loose talking a grave concern in India.
Establishing and maintaining patients’ trust in their caregivers is critical to obtaining a complete history, an accurate health record, and carrying out an effective treatment plan. If a nurse fails to protect the patient’s privacy, the erosion in the relationship can have dire consequences to the nurse-patient relationship, or even the doctors.
Even though most healthcare professionals know the limits of confidentiality well, they have trouble applying them to their behaviour, more so we have many new resident doctors who are enthusiastic to have the picture of medical procedures in these mobiles or smartphones, and discuss undesired facts on serious patients. Next comes the doctors, residents and nurses discussing the condition of the patient in the moving lifts with so many strangers may be related to patient.
I am sorry that we do not have a system to protect the confidentiality to declare a patient, he is HIV positive and the news goes viral in minutes to the concerned and unconcerned people which will lead to legal and ethical challenges to the hospital administration. Today, we find many medical students and juniors playing fun with the smartphones in their hands.
My own observation in one hospital where I have worked was that the junior doctors were playing with iPad and chatting; a little child dies under observation in the causality and the patient’s relatives attribute everything to their negligence and rough up the duty doctors and ransack the hospital’s valuable instruments. However, the hospital authorities have kept the CCTV surveillance at major areas in the hospitals; with evidence the police could not do anything and blame the doctors for not being attentive to the work; it means the patients want the attention at every stage, as they are paying we are at the receiving end.
The privacy and security of patients not in effective care health information, however it is a top priority for patients and their families, healthcare providers and professionals, and the government. Our laws are not clear on many matters on cyber laws, however we should have accountability and we require many of the key persons and organizations that handle health information to have policies and security safeguards in place to protect our health information — whether it is stored on paper or electronically.
Privacy and confidentiality are basic rights in our society and guaranteed to every citizen. Safeguarding those rights, with respect to an individual’s personal health information, is our ethical and legal obligation as healthcare providers. Doing so in today’s healthcare environment is increasingly challenging. Every doctor and nurse understands and respects the need for patient’s confidentiality. As professionals, our connection to our patients and our colleagues depends on it. But the truth is, with advanced technology, new demands in healthcare, and developments in the world-at-large, make it more and more difficult to keep this promise. But keep it we must!
It is our duty to protect the wellbeing of those who are entrusted to our care. Protecting the integrity of the doctor/nurse-patient relationship and patients’ rights is a sacred trust. It is also our duty to periodically remind doctors and nurses of the importance of keeping the patient information private. I wish there should be competent control on the young doctors’ ethical behaviour with digital information and should be oriented in the cyber laws in relation to procedures conducted as part of medical treatment, above all the patients’ privacy and records.
Ref: Caring for Patients While Respecting Their Privacy: Renewing Our Commitment – by Jeanette Ives Erickson, Sally Millar
Dr T V Rao
Professor of Microbiology
Travancore Medical College, Kollam (Kerala)