PCM Confidentiality Lecture Notes PDF

Level 1 - Semester 1 PCM LECTURE (8) CONFIDENTIALITY DR ZIAD MAHANA  FAMILY MEDICINE Gynecology - 1 0 CONFIDENTIALITY (PROFESSIONAL...

Level 1 - Semester 1 PCM LECTURE (8) CONFIDENTIALITY DR ZIAD MAHANA  FAMILY MEDICINE Gynecology - 1 0 CONFIDENTIALITY (PROFESSIONAL SECRECY) D EFINITION OF CONFIDENTIALITY The duty of the doctor, pharmacist & other medical personnel to keep the secrets they know about the patient away from divulge (i.e. the doctor must not divulge patient secrets), except in certain conditions. Privacy VS Confidentiality Ø The terms “privacy” and “confidentiality” have been used together in much of teaching. Thus, many may think they are synonymous when they are not PRIVACY CONFIDENTIALITY þ Concerned with the setting within which the þ Concerned with the information collected patient’s medical information is taken from/about the patient (i.e., the patient’s body). (i.e. The patient’s information). þ About right of an individual to have þ About right or expectation not to be personal, identifiable medical information interfered with and to be left alone. kept out of reach of others. Notes MEDICAL JOURNALS are not allowed to publish names or photographs of the patient. HOSPITALS must keep information & investigations concerning any patient away from non-responsible persons. Dr. Ziad Mahana 1  PCM LECTURE - 8 CONFIDENTIALITY þ All identifiable patient information is subject to the duty of confidentiality. þ Information may be: INCLUDES o Written – computerized or o Recorded (visual or audio) or o Simply held in memory of health professionals. ❶ The individual’s past, present, or future physical or mental health or condition. ❷ Any clinical information about an individual’s diagnosis or treatment. ❸ Pictures, photographs, videos, audiotapes, or other materials of the patient. COVERS ❹ Who the patient’s doctor is and what clinics patients attend and when. ❺ Anything else that may be used to identify patients directly or indirectly. ❻ The past, present, or future payment for the provision of health care to individual. MeSuEsToPrTeTAtEn’sPrVaY ❶ Make sure all physical examinations take place in isolation from other patients, unauthorized family members, and/or staff. PLACE ❷ It is prohibited to examine the patient in the corridors or waiting areas. ❸ Ensure privacy when taking information from patients. ❹ Provide gender-sensitive waiting and examination rooms. ❶ Always take permission from the patient before starting any examination. EXAMINATION ❷ Give patients enough time to expose the part with pain. ❸ Avoid keeping patients for periods more than required by the procedure. ❶ Provide proper clothing for inpatients. PATIENT BODY ❷ Make sure your patient’s body is exposed ONLY as much as needed by the examination or investigation. Dr. Ziad Mahana 2  PCM LECTURE - 8 ❶ Make sure patients are well covered when transferred from one place to TRANSFER another in the hospital. ❷ Patients should have separate lifts and be given priority. ❶ Make sure there is another person (nurse) of the same gender as the patient present throughout any examination. ATTENDING PERSONNEL ❷ Only relevant personnel allowed to enter examination room at any time during examination (No unrelated non-hospital person should be allowed to be present). MeSuEsToPrTeTOnIdNtAlTyOfPaIeT’sInOrAtOn Ø It is mandatory that whatever a doctor sees or hears in the life of his patient must be treated as totally confidential (Disclosure would be failure of trust & confidence). Ø Main measures you (with your institution) need to follow when dealing with patients’ information: ❶ Clinical details should be separated from demographic data. EMAIL & FAX ❷ All data transmitted by email should be encrypted. ❶ Always log out of any computer system or application when work is finished. ❷ Do not leave a terminal unattended and logged in. ELECTRONIC ❸ Do not share Smartcards or passwords with others. RECORDS ❹ Change passwords at regular intervals to prevent others using them. ❺ Always clear screen of a previous patient’s information before seeing another. ❶ Hold in secure storage. ❷ Tracked if transferred, with a note of their current location within filing system. MANUAL ❸ Return to the filing system as soon as possible after use. RECORDS ❹ Stored closed when not in use so that the contents are not seen by others. ❺ Kept on site unless removal is essential. Dr. Ziad Mahana 3  PCM LECTURE - 8 ❶ Never inappropriately access records. ALL ❷ Shut/lock doors, offices, and filing cabinets. RECORDS ❸ Query the status of visitors/strangers. ❹ Advise senior personnel if anything suspicious or worrying is noted. ① Discuss patient’s medical information with unauthorized family members. ② Disclose patient’s information (without his/her consent, or in established exceptions). ❶ DO NOT ③ Collect information not related to the provision of care. ④ Answer any query by third parties, even when enquired by GENERAL close relatives, either with regard to the nature of illness or MEASURES any subsequent effect of such illness on the patient, without his/her consent. ❷ SET POLICIES ① Regulate access to medical information. THAT ② Address how any breach to confidentiality is managed. ① Sharing of information with other staff ❸ LIMIT (Unless in cases of consultations and second opinion). ② Accessibility to the medical records. PrViEgDOmUnCaIoS (CoDiIoSFErIsIbEIsLoUr o pOfSsOnLEcEt) D E F I N I T I O N O F P R I V I L E GE D C O M MU N I C A T I O N S An exchange of information between 2 individuals in a confidential relationship. An exception to professional secrecy. statement, made by a doctor to concerned authority, due to his duty to protect interests of the community or of the state Dr. Ziad Mahana 4  PCM LECTURE - 8 DISCLOSURE TO BE PRIVILEGED - ‫ﺻﺎﺣب اﻣﺗﯾﺎز‬ THE PLEA (‫ ) اﻻﻟﺗﻣﺎس‬OF PRIVILEGE FAILS þ Must be made to person who has a þ IF MADE TO: duty towards it. § one person or § To person who has not got direct interest in it. Ø The doctor is obliged to maintain the secrets that he comes to know concerning the patient in the course of a professional relationship EXCEPT: þ If the patient asks or permits (consented) for this disclosure. ON REQUEST OF þ Relatives & parents are not allowed to know his own secrets even after 1 PATIENT HIMSELF death and even if “husband and wife”, it is not allowed to disclose information. þ If the patient is mentally diseased: His relatives should be notified for proper care & treatment. PATIENT þ A doctor can disclose & discuss medical facts of a case with other doctors & paramedical staff (nurses, radiologist & physiotherapist) to provide better service to the patient. þ In cases of infectious diseases e.g. typhoid and AIDS: FOR THE SAKE OF To prevent propagation of the disease everywhere. 2 If the patient refuses advice or treatment: PUBLIC He/she should be told that the proper authorities will be notified. þ In cases of diseases that is contraindicated to his job: § Drivers: uncontrolled hypertension § Bathers in swimming pools: Gonorrhea MEDICAL þ If he is accused by malpractice: MEN He is allowed to divulge secrets about diagnosis & treatment followed. þ When he is required by the law to divulge the secrets. þ When a medicolegal expert is asked to give a certain report in a certain 3 IN CASES OF problem. EXPERT WITNESS þ Medical persons working for insurance company can refuse to give a report about one of his own patients. Dr. Ziad Mahana 5  ‫‪PCM‬‬ ‫‪LECTURE - 8‬‬ ‫‪LeAlImLiAtOn‬‬ ‫‪The patient can sue the doctor for damages or face disciplinary action, if the disclosure is:‬‬ ‫& ‪§ Voluntary‬‬ ‫& ‪§ Has resulted in harm to the patient‬‬ ‫‪§ Is not in the interest of public.‬‬ ‫‪Note‬‬ ‫§ ﻻ ﯾﺠﻮز ﻟﻠﻄﺒﯿﺐ إﻓﺸﺎء أﺳﺮار ﻣﺮﯾﻀﮫ اﻟﺘﻰ اطﻠﻊ ﻋﻠﯿﮭﺎ ﺑﺤﻜﻢ ﻣﮭﻨﺘﮫ إﻻ إذا ﻛﺎن ذﻟﻚ ﺑﻨﺎء ﻋﻠﻰ ﻗﺮار ﻗﻀﺎﺋﻲ أو ﻓﻰ ﺣﺎﻟﺔ‬ ‫إﻣﻜﺎن وﻗﻮع ﺿﺮر ﺟﺴﯿﻢ وﻣﺘﯿﻘﻦ ﯾﺼﯿﺐ اﻟﻐﯿﺮ أو ﻓﻰ اﻟﺤﺎﻻت اﻻﺧﺮي اﻟﺘﻰ ﯾﺤﺪدھﺎ اﻟﻘﺎﻧﻮن )اﻟﻤﺎدة ‪ – ٣٠‬ﻻﺋﺤﺔ آداب‬ ‫اﻟﻤﻨﮭﺔ(‬ ‫)ﻻﺋﺤﺔ اداب اﻟﻤﮭﻨﺔ – رﻗﻢ ‪ 238‬ﺑﺘﺎرﯾﺦ ‪(2003/9/5‬‬ ‫‪Dr. Ziad Mahana‬‬ ‫‪6‬‬