Monday, September 13, 2021

Confidentiality in lab reports

Confidentiality in lab reports

 

Case: Do not tell my wife

Ramratan was in tears. “How is it possible doctor? We are expecting our son soon.

He will not have a father”. Ramratan had seen you with vague aches, fever, weight loss

and cough with expectoration not responsive to antibiotics for the past three months. He had a right mid zone lung shadow on X-ray and the sputum was positive for AFB. On

being questioned, he had revealed that he had unprotected sexual intercourse with multiple partners 3 years ago. “But I stopped after I married Danno, doctor - I am faithful to her”.

An informed consent was obtained and HIV screening test was ordered and it was positive.

A confirmatory test was subsequently obtained and it was also positive. The CD4 count

was< 100. Ramratan had come to discuss the results of his HIV test. After consoling him

and writing out prescriptions for TB and HIV, you mention to him that he must bring his

wife for testing. “This is important, Ramratan”, you add - “especially since she is

pregnant.”

“Absolutely not, sir!” he explosively retorts. “That is not possible. I will be

humiliated. Danno will leave me and go. I will never be able to see my son. I will become an outcast in our community. I can’t live without my wife, doctor. I urge you, doctor -

don't do this. I forbid you…”

 

Patient confidentiality

Confidentiality is the right of an individual to have personal, identifiable medical information kept private. It means that personal and medical information given to a health care provider will not be disclosed to others unless the individual has given specific permission for such release. Confidentiality respects patient privacy and autonomy.

Ethically, confidentiality is derived from the principles of autonomy (the patient determines who shall know his or her medical history) and fidelity (the fiduciary relationship of the patient and physician requires trust and confidence). Confidentiality allows the physicians to obtain all the information necessary to make a complete diagnosis and motivate the patient to participate in therapy.

The patient has the right to confidentiality. The physician should not reveal confidential communications or information, without the consent of the patient, unless provided for by law, for the need to protect the welfare of the individual, or for public interest.The confidentiality of physician-patient encounters is a basic medical ethic, reflected in the Hippocratic Oath.


 

What information is confidential?

All identifiable patient information, whether written, computerised, visual or audio recorded or simply held in the memory of health professionals, is subject to the duty of confidentiality. Confidentiality of Laboratory results must be maintained at all times.

Give medical information to patient first, Not the family/friends

The doctor must convey medical information to the patient first. Without direct instruction from the patient, the family/friends should never receive the patient's confidential medical information. It is patient’s decision whether he/she wants her family/friends to know about his/her medical condition. There is a rare exception in the case of a patient with a psychiatric illnesses whom to inform if the medical illness induce a suicidal attempt.

Release of information to family, friends or colleagues

Confidentiality also includes keeping a patient's medical information private even from his friends and family unless the patient expressly consents that it is okay to release the information to them. The patient may have a good relationship with his family and friends but this is absolutely no excuse to assume that the patient wants his/her medical information passed on to them. It may seem rude and unreasonable but you must tell the patient's family members/friends that you must ask your patient for permission before you release patient’s medical information. The doctor must keep the medical information private from a patient's co-workers as well.

Release of information to other doctors

Information transfer between doctors involved in the care of patient is common. However, the medical information about the patient can only be transferred if the patient has signed a consent form requesting the transfer of information. The patient must sign the consent form, not the health care providing doctor. The referred doctor must demand for the signed consent form for release of information by the patient from the referring doctor.

Release of information to the governmental organizations and courts

If the doctor receives a court order from authorized law personnel, that constitutes a search warrant then the doctor must furnish the information that he/she requests. If the investigator does not have a search warrant, then the doctor must refuse him access to the patient’s files. The doctor is not under any obligation to provide any information related to patient to third parties unless it is at the request of the patient.


 

Exceptions to confidentiality:

The principle of confidentiality is never absolute and has always been subject to limits in the interest of society, public welfare, and the rights of other individuals. The patient’s right to confidentiality is less important than another person’s right to safety. In such cases the confidentiality can be broken in order to protect others. For example, a mentally ill patient tells the psychiatrist that he/she intents to harm someone. In such case, the psychiatrist must inform the law enforcement and the potential victim. Other case where it is lawful to break the confidentiality include partner notification for sexually transmitted diseases such as syphilis and HIV infections.

Exceptions to patient confidentiality include the following:

• Suicidal/homicidal patients

• Abuse (children, elderly, and/or prisoners)

• Duty to protect- State-specific laws that sometimes allow physician to inform or somehow

protect potential Victim from harm.

• Epileptic patients and other impaired automobile drivers.

• Reportable Diseases (eg, STDs, hepatitis, food poisoning); physicians may have a duty to warn public officials, who will then notify people at risk. Dangerous communicable diseases, such as TB or Ebola, may require involuntary treatment.

Medical records

The doctor/health care facility physically owns the medical record, but the information within it is the property of the patient. The patient has an absolute right to free access to the information it contains without providing any reason to the doctor/health care facility. The information within medical records is covered by the same rules of confidentiality. You cannot release the information within medical records without patient’s consent to anyone. No one except those involved directly with patient care has a right to access the information within patient’s medical records. Doctors/health care facility cannot hold medical records as “hostage" to compel a patient to pay medical bills. The need of information to take care of patient is more important than the doctor’s right to payment.


 

How to maintain confidentiality?

Doctors often violate ethics not because they mean to, but because they are careless. As a matter of fact, they sometimes act with good intentions.

·       Handle medical records as confidential documents.

·       Do not leave patient information and laboratory results unattended on printers, desks etc.

·       Protect information on Computer screens by screen saver / time out functionalities.

·       Should a person call requesting results and there is a question about the person’s identity, the requestor is asked for his/her name and phone number where they can be called back.

·       Check that fax numbers are correct before sending confidential information and laboratory results.

·       Patient information should never be discussed with friends or relatives in a social setting.

·       Do not discuss with family or friends patients details and if asked inform them that you are not permitted to disclose any information. This includes patient names.

·       Do not discuss patient information with the media.

·       Every health care organization should have a policy that defines confidentiality and delineates who is responsible for maintaining it. A good policy will state that every person who works for the organization is responsible for ensuring patient confidentiality and for reporting. policy violations. It also will state that managers are responsible for implementing and enforcing the policy as it pertains to their areas. Information about patients should be accessed or discussed only on a need-to-know basis, according to job duties. To protect against lawsuits, organizations should present the policy to new employees in orientation, and have all employees sign a statement that they are aware of the policy.

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Confidentiality in lab reports

  Case: Do not tell my wife Ramratan was in tears. “How is it possible doctor? We are expecting our son soon. He will not have a fathe...