Doctor-Patient Confidentiality

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Questions and Answers

What is the foundation of trust in the doctor-patient relationship, according to ethical principles?

  • The legal obligation to provide care.
  • The doctor's expertise in diagnosis.
  • The confidentiality of patient information. (correct)
  • The patient's ability to pay for treatment.

Which of the following best describes the scope of patient information that is subject to the duty of confidentiality?

  • Only clinical information related to diagnosis and treatment.
  • Only information that patients explicitly designate as confidential.
  • All identifiable patient information, regardless of how it is stored or recorded. (correct)
  • Only written and computerized information.

From an ethics standpoint, what is the primary significance of patient autonomy in the context of confidentiality?

  • It ensures doctors can practice without interference.
  • It affirms the patient's right to control their personal information. (correct)
  • It provides a legal framework for data protection.
  • It supports the doctor's decision-making authority.

In what way does the legal framework in the UK protect patient confidentiality?

<p>It emphasizes the right to respect for private and family life. (D)</p> Signup and view all the answers

Which factor would be most important when evaluating whether to use patient data for medical research?

<p>Obtaining prior consent and anonymizing the data. (C)</p> Signup and view all the answers

Which scenario represents a common breach of patient confidentiality?

<p>A medical student accesses a patient's record without a direct role in their care. (A)</p> Signup and view all the answers

What is the most important consideration in avoiding accidental breaches of patient confidentiality?

<p>Ensuring patient notes are not left in areas with open access. (A)</p> Signup and view all the answers

What extends to social networking sites regarding guidelines for patient confidentiality?

<p>The duty to protect patient confidentiality extends to the Internet. (D)</p> Signup and view all the answers

How are medical students held regarding patient confidentiality?

<p>They are bound by the rules of confidentiality similarly to qualified doctors. (C)</p> Signup and view all the answers

In what situation might breaching patient confidentiality be ethically justified?

<p>When there is a real and imminent threat of harm to the patient or others. (D)</p> Signup and view all the answers

What consideration should be paramount when deciding whether to breach confidentiality in the public interest?

<p>Whether the public interest in breaking confidentiality outweighs the interest in maintaining it. (C)</p> Signup and view all the answers

Under UK law, in which of these situations is breaching patient confidentiality legally required?

<p>When dealing with notifications of births and deaths. (D)</p> Signup and view all the answers

What should a doctor do if they have a patient who is medically unfit to drive?

<p>Ensure that the DVLA (Driver Vehicle and Driving Agency) is aware of the patient's condition. (A)</p> Signup and view all the answers

In handling a minor who is sexually active, what presents an especially difficult ethical area?

<p>Balancing the need to explore abuse versus consensual activity. (B)</p> Signup and view all the answers

When can you breach confidentiality against a child's wishes?

<p>If it is in the best interest of an incompetent child. (C)</p> Signup and view all the answers

Under what circumstance is a doctor required to notify a local authority officer?

Signup and view all the answers

Beyond the moral duty to maintain confidentiality, doctors also have a legal duty. Which of the following scenarios best exemplifies this legal duty?

<p>A physician being compelled by a court order to disclose a patient's medical records in a criminal investigation. (A)</p> Signup and view all the answers

What is the most precise definition of 'identifiable patient information' that is subject to confidentiality?

<p>Any information, whether written, electronic, or memorized, that could directly or indirectly identify a patient. (A)</p> Signup and view all the answers

A doctor argues their breach of patient confidentiality was justified because it ultimately benefited the patient's health. Under what broader ethical principle might this argument fall?

<p>Consequentialism (D)</p> Signup and view all the answers

How do privacy rights relate to patient autonomy concerning confidential medical information?

<p>Patient autonomy ensures that individuals have the right to decide who can access their personal information and to authorize such access. (A)</p> Signup and view all the answers

In the UK legal framework, which legislation specifically addresses the regulation of patient information within the health and social care system?

<p>Health &amp; Social Care Act 2012 (A)</p> Signup and view all the answers

Naomi Campbell's case against MGN (2004) highlights the distinction between privacy and confidentiality. Which statement best describes the central issue regarding this distinction?

<p>The case centered on whether publishing photographs, in addition to addiction details, constituted a breach of confidence, despite the public acknowledgement of said addiction. (B)</p> Signup and view all the answers

When is the use of patient data in medical research ethically acceptable?

<p>When the data is anonymized and prior consent is obtained. (A)</p> Signup and view all the answers

Why is using interpreters during medical consultations a potentially common breach of confidentiality?

<p>The interpreter gains access to sensitive patient information, creating a risk of unauthorized disclosure. (A)</p> Signup and view all the answers

In order to prevent accidental breaches of patient confidentiality, which policy would be most important to implement?

<p>Ensuring that computers, faxes, and printers are secured and information is not left unattended. (B)</p> Signup and view all the answers

Considering the potential risks to patient confidentiality, what is the best course of action for medical professionals when communicating on social media?

<p>Be mindful not to disclose any identifying information that could breach patient confidentiality. (C)</p> Signup and view all the answers

What level of accountability do medical students have regarding patient confidentiality?

<p>Medical students are bound by the same rules of confidentiality as qualified doctors. (A)</p> Signup and view all the answers

In which of the following situations would breaching patient confidentiality be ethically justifiable?

<p>To prevent a real and imminent threat of harm to the patient or others. (A)</p> Signup and view all the answers

In deciding whether to breach confidentiality in the public interest, what should be the primary factor?

<p>Whether the public interest in disclosure outweighs the public interest in maintaining confidentiality. (B)</p> Signup and view all the answers

Under UK law, in which case is breaching patient confidentiality legally required?

<p>When required by a court order. (A)</p> Signup and view all the answers

What is a doctor's obligation if they determine that a patient is medically unfit to drive?

<p>To advise the patient of their condition and the potential risk, and ensure that the DVLA is aware of the situation. (A)</p> Signup and view all the answers

What additional factor creates a particularly complex ethical issue when handling a minor who is sexually active?

<p>The potential conflict between the minor's right to confidentiality and the parents' right to know. (B)</p> Signup and view all the answers

In what specific circumstance involving a child can a doctor justifiably breach patient confidentiality against the child's wishes?

<p>When it is in the overriding public interest, the best interest of an incompetent child, or disclosure is required by law. (A)</p> Signup and view all the answers

Under what specific condition related to communicable diseases might a doctor be legally obligated to notify a local authority officer?

<p>When they suspect a patient of having an infectious disease, such as TB or COVID-19. (A)</p> Signup and view all the answers

What is the most appropriate initial step to take when a doctor receives a request from the police to report details about a patient?

<p>Explain that the police do not have automatic power to demand disclosure and ask for a written request. (B)</p> Signup and view all the answers

What is the primary consideration for a doctor when faced with the scenario of a colleague using images of a patient with skin cancer in an international conference presentation?

<p>Verifying that the patient has given explicit consent for the use of their images. (C)</p> Signup and view all the answers

Under what circumstance is a doctor permitted to disclose information to a patient's sexual partner?

<p>If the doctor has reason to believe they are at risk of infection and that the patient has not informed them or has refused to do so. (C)</p> Signup and view all the answers

According to GMC guidance, how should doctors approach disclosing information about a patient?

<p>Keep disclosures to the minimum necessary for the purpose. (C)</p> Signup and view all the answers

What does the Susan Axon Case highlight about confidentiality for minors in the UK?

<p>That minors who are considered competent to consent are entitled to confidentiality in the same way as competent adults. (A)</p> Signup and view all the answers

What is true of a doctor's ethical duty of confidentiality after a patient's death?

<p>The ethical duty remains the same even after death. (C)</p> Signup and view all the answers

Which of the following scenarios best illustrates a consequentialist justification for breaching patient confidentiality?

<p>A doctor discloses a patient's history of violence to the police, believing it will prevent future harm to others despite the lack of immediate threat. (A)</p> Signup and view all the answers

A doctor in a small town inadvertently reveals a patient's diagnosis while chatting with a neighbor at the local grocery store. This scenario best exemplifies which type of confidentiality breach?

<p>An accidental breach (C)</p> Signup and view all the answers

Which of the following situations falls under 'secondary uses of information'?

<p>Using anonymized patient data for medical research after obtaining consent. (D)</p> Signup and view all the answers

A doctor receives a call from a long-term care facility requesting an update on a patient, Mark, who was admitted to the hospital with dehydration and delirium and is expected to eventually return to the facility. Can the hospital doctor share this information with the long-term facility?

<p>The hospital doctor can likely share the information under the presumption of implied consent, but should document this clearly. (D)</p> Signup and view all the answers

Which of the following is a requirement that must be satisfied to establish a duty of confidentiality?

<p>The information in question must have an inherent quality of confidentiality. (B)</p> Signup and view all the answers

Which of the following represents a legally required reason to breach confidentiality under statute law in the UK?

<p>Notifying authorities about traffic accidents. (D)</p> Signup and view all the answers

What should a doctor do if they are one of your patients, James has Hepatitis B. James is sexually active and has told you that he never uses barrier contraception because “it is not very romantic”. His partner, Harriet, is also a patient of yours and you know that James has not informed Harriet about his Hepatitis. Should you disclose the information?

<p>Disclose information to a patient's sexual partner ...“if you have reason to believe they are at risk of infection and that the patient has not informed them or has refused to do so”. (B)</p> Signup and view all the answers

What is most important to consider when thinking about patient confidentially and children?

<p>The same duties of confidentiality apply when using, sharing or disclosing information about children and young people as about adults (A)</p> Signup and view all the answers

What are the conditions that establish a Duty of confidentiality

<p>All of the above (D)</p> Signup and view all the answers

What is the main idea about confidentiality and death?

<p>All of the above (D)</p> Signup and view all the answers

What is true of consequentialist justifications?

<p>Doctor may breach patient confidentiality with the intention of preventing future harm (C)</p> Signup and view all the answers

What would you consider as a common breach of of confidentiality?

<p>Doctor inadvertently reveals a patient's diagnosis while chatting with a neighbor at the local grocery store (C)</p> Signup and view all the answers

Based on secondary uses of information, which action is acceptable?

<p>Using anonymized patient data for medical research after obtaining consent. (C)</p> Signup and view all the answers

A doctor discloses confidential patient information without explicit consent, believing it is in the patient's best interest due to their impaired cognitive function. Under which broader justification might this fall?

<p>The patient's best interests (C)</p> Signup and view all the answers

In the UK, which of the following legal frameworks provides a patient the right to respect for private and family life, impacting how confidentiality is handled?

<p>The Human Rights Act 1998 (A)</p> Signup and view all the answers

Why is anonymization crucial when using patient data for medical research?

<p>It prevents identification of individuals, upholding their right to privacy and confidentiality (C)</p> Signup and view all the answers

Which practice poses a risk of inadvertently breaching patient confidentiality in a hospital setting?

<p>Leaving patient notes unattended in a public area (C)</p> Signup and view all the answers

How does the principle of minimizing disclosure relate to handling patient information?

<p>It means only disclosing the minimum necessary information to achieve a specific purpose. (D)</p> Signup and view all the answers

Under what specific condition is a doctor permitted to disclose information to a patient's sexual partner without the patient's consent?

<p>If the doctor has reason to believe the partner is at risk of serious harm and the patient has not informed them (C)</p> Signup and view all the answers

If a patient has died, what is true of a doctor's confidentiality?

<p>The ethical duty of confidentiality still remains (B)</p> Signup and view all the answers

What is one of the elements required to establish a duty of confidentiality?

<p>The information is given in a clinical setting (B)</p> Signup and view all the answers

A doctor receives a request from the police for patient details unrelated to a traffic accident, serious crime, kidnapping or terrorist act. What should the doctor do?

<p>Ask for a written request (D)</p> Signup and view all the answers

What is it important to consider about children and confidentiality?

<p>The same duties of confidentiality apply to children and young people as adults (B)</p> Signup and view all the answers

Flashcards

Moral duty of confidentiality

Trust in the doctor-patient relationship relies on keeping patient information private.

Legal duty of confidentiality

It is a legal requirement to protect patient information obtained during a medical consultation.

Identifiable patient information

Any information that could identify a patient, whether written, electronic, or remembered, is confidential.

Ethical basis of confidentiality

Respecting privacy is part of respecting a person's autonomy and rights.

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Doctor's duty

Maintaining confidentiality builds trust in doctors and upholds ethical standards.

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Legal Framework

HIPAA, GDPR and the Human Rights Act

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Secondary uses of information

Using patient data for research, audits, or presentations requires consent and anonymization.

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Accidental breach of confidentiality

Discussions in public areas, unfiled notes, and unsecured computers can unintentionally reveal patient information.

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Medical students and confidentiality

Medical students must follow the same confidentiality rules as qualified doctors.

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Limits to confidentiality

Disclosing information is permissible if the patient consents, or if required by law.

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Justifications to break confidentiality

Patient consent, protecting public interests, and legal requirements

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Legal requirements to break confidentiality (UK Statute Law)

Child abuse, drug addiction and terrorist plots.

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Confidentiality in specific cases

Doctors must report unfit drivers to the DVLA and follow child protection guidelines.

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Responsibilities with gunshot or knife wounds

Doctors generally inform the police in this case

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Confidentiality & Children

A child's information can be shared overriding public interest.

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Sharing STI information.

Evaluate harms, and follow guidance.

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Disclosing information about a patient.

Aim to use anonymized data and only disclose the minimum necessary.

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Disclosure of information about Death

Legally obligated for death certificate etc.

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Study Notes

Duty of Confidentiality

  • Confidentiality is a key aspect of doctor-patient interactions, involving both ethical and legal obligations

  • A moral duty dictates that trust in the doctor-patient relationship hinges on confidentiality

  • A legal duty exists not to reveal information obtained during medical consultations

Confidential Information

  • All identifiable patient information, be it written, computerized, visual, audio-recorded, or simply remembered, falls under the duty of confidentiality

  • This includes clinical details like diagnosis and treatment but also pictures and the identity of the patient's doctor

  • Ethical basis rests on autonomy, wherein personal information belongs to the patient, who can decide and authorise who has access to it

  • Doctors should be sensitive, trustworthy, and respectful of patient confidences

  • Doctors have a duty of virtuois behavior in the medical context

  • Legal compliance also matters, as violating confidentiality can lead to legal and professional repercussions

  • Confidentiality is a precondition for sharing in the doctor-patient relationship, essential for accurate diagnosis and effective treatment

  • Breaching confidentiality constitutes breaking a promise

  • Legal duty of confidentiality under law protects doctors that maintain confidentiality

  • Legal duty of confidentiality under law protects society or individuals from harm

  • Information must inherently be confidential, like personal data from medical consultations

  • Sharing information in a clinical setting implies a confidential obligation

  • Unauthorised disclosure can lead to consequences for the provider

  • HIPAA in the US (1996)
  • GDPR in Europe (2018) controls how personal information is used by organizations, businesses, or the government, while maintaining data security

UK Legalities

  • Human Rights Act of 1998 grants the right to respect private and family life, life, and freedom of expression
  • Data Protection Act 1998 (amended 2018) and the GDPR (2018) regulate data protection
  • Health & Social Care Act 2012 (UK) regulates patient information

Privacy vs. Confidentiality

  • Naomi Campbell sued the Daily Mirror (MGN) for publishing about her drug addiction, arguing a breach of privacy, even though she'd made public statements denying drug use
  • Protecting patient information is a core value in healthcare

Secondary Uses of Information

  • Using data in medical research needs prior consent and anonymization
  • Clinical audits are usually under implied consent
  • Conference presentations or educational materials need prior consent

Common Breaches of Confidentiality

  • Breaches often occur in routine situations, like sharing patient records with nurses and medical students
  • Using interpreters when doctors and patients don't share a language can similarly also be a breach
  • Disclosing to proxy decision-makers or family in critical care or after a patient's death may also lead to breaches

Accidental Breaches

  • Lapses in patient confidentiality are widespread

  • These can occur in crowded places like lifts and canteens, or in A&E departments and wards

  • Leaving patient notes in open access areas or failing to secure computers, faxes, and printers causes breaches

  • The Health Secretary Jeremy Hunt accidentally breached patient confidentiality (2005) after he tweeted a photo from a hospital with confidential details on the board in the background

  • Social networking poses risks if users aren't careful about sharing identifying information online and also may be accused of misconduct

Confidentiality & Medical Students

  • Medical students must follow the same confidentiality rules as qualified doctors

  • Students have access to confidential information and legal responsibilities, including accidental or minor breaches

  • Breaching confidentiality is not absolute

Limits to Confidentiality

  • The WMA's International Code of Medical Ethics (2006) states information can be disclosed if the patient agrees or if there’s a real threat of harm to self or others

Breaking Confidentiality

  • Is justified with patient consent, in the patient’s best interest, or for public safety, if the law requires or a statutory process approves
  • Legal requirements to break confidentiality include notifications of births, termination of pregnancy, fertility treatment, and instances of notable diseases
  • Legal requirements to break confidentiality include notifying authorities about poisonings and serious workplace accidents, criminal investigations, and terrorism

Problems: The Impaired Driver

  • Involves notifying the DVLA about fitness to drive, disclosing for public safety, and doctors ensuring awareness of medically unfit drivers

Problems: Abused Patient

  • Reporting under Child Protection and Safeguarding is important in cases with children
  • It is important to Note the intervention limits with adult capacitous patients

Problems: Gunshot or Knife

  • Health Professionals should police and consider how patient poses risk of serious harm

  • Police need no automatic powers to demand disclosure, exceptions include traffic accidents, serious crimes

  • Note the Good practice to ask for written request

Confidentiality & Children

  • The same confidentiality duties apply to information about children and young people
  • Breaching confidentiality against a child's wishes is permissible if to override for public interest, the best interest of an incompetent child, or if the disclosure is required by the law

Problems: Sexually Active Minor

  • Explore abuse vs consented
  • Young people have the need to trust the confidentiality of general practice
  • Note UK studies are concerned over confidentiality

Adolescents & Confidentiality

  • Mrs Axon had a provision over parental rights over abortion
  • Over 13-15 can consent
  • However: Operation on under 16yrs preferable to get parental consent.

Problems: Communicable Disease

  • Public Health (Infectious Diseases) Regulations 1988;Coronarivus Act 2020
  • Diseases like TB or COVID-19 must be notified
  • AIDS/HIV are not notifiable.
  • There must be serious interest as well

James has Hepatitis B

  • Note that there must be Consideration of non-disclosure, harms of disclosure, ethics, law
  • If you have reason to believe they are at risk of infection and that the patient has not informed them or has refused to do so”,

Professional Guidance Summary

  • Duty: GMC Confidentiality = Not absolute, can disclose personal information, if consented to by patient
  • The disclosure is of overall benefit of capacity to consent
  • D: Disclosure can be justified in public of interest

Disclosure Summary

  • Use anonymised information, be satisfied that the patient
  • Explicit consent for identified if not local care
  • Keep disclosure to relevant only

Confidentiality of Death

  • Ethical duty of confidentiality - remains as it was for death
  • Includes legally obligated details for the death certificate and for clinical audits

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