6


Breaching confidentiality


their confidentiality absolute. However, inadvertent breaches of confidentiality remain a common cause of patient complaint and dissatisfaction. Healthcare


I


is a multidisciplinary team process – you need to share information about patients with colleagues and other agencies. You also have a responsibility to act in the public interest, when the health and safety of others is endangered. So you will need to become comfortable with making decisions on these boundaries. Disclosures should be


with the consent of patients whenever possible, kept to a minimum and anonymised where this will suffice. You should also ensure that any decisions you make are recorded, together with the reasoning behind them. Practices should have a confidentiality statement that includes a clause to cover staff when they are no longer working at the practice, and should ensure that all staff receive and sign a copy, including the practice- employed cleaner.


Sharing with colleagues All healthcare professionals have a professional ethical duty to respect patients’ confidentiality and should only access records if they are involved in the patient’s care. This is on a “need-to- know” basis. Whilst it is assumed that patients consent to their personal information being


t would be impossible to care for patients effectively while keeping


shared among the clinical team for the purposes of their care, they should be made aware that this is the case and told that they have the right to withhold consent. Sometimes, patients may


ask for certain – usually extremely sensitive – information to be kept private and you should respect this. However, in certain circumstances, this information may need to be released if failure to disclose would place others at risk of death or serious harm.


........................................


“ Inadvertent breaches of confidentiality


remain a common cause of patient complaint and dissatisfaction


........................................


Administrative staff Administrative staff should have immediate access to information only on a “need-to-know” basis. When using computerised records, administrative data, such as names and addresses, should be accessible separately from clinical information, so that sensitive data is not automatically displayed. This will help reduce the risk of accidental breaches of confidentiality in reception areas or other areas to which patients have access. All staff that have access to clinical information must have a full understanding of their duty of confidentiality, and understand their responsibilities.


Death certificates Relatives may sometimes ask for certain information about the deceased, for example their HIV status, to be omitted from death certificates. Be prepared for this, and advise them that you have a legal duty to complete death certificates fully and honestly.


Disease registers and public health initiatives A variety of professional and government organisations rely on information from patients’ records. These include public health initiatives and cancer registries. You must adhere to the Medical Council’s principles of confidentiality if registers are being kept, and you should be aware of any specific legislative provisions in relation to disease registries.


Primary healthcare teams Many GPs are now involved in primary healthcare teams and in some instances clinical cases are discussed in venues away from the practice. It is important to affirm a commitment to confidentiality with colleagues in related health professions eg, physiotherapy or occupational therapy. It is worth considering whether a patient should be specifically advised that their case will be discussed in such a way and consent obtained.


Disclosure of information


There are a number of specific situations that require disclosure of information:


Notifiable diseases Notification of infectious diseases is made to the office of the Director of Public Health. Area medical officers are assigned to deal with the management of infectious disease. They offer a lot of useful advice and are worth contacting for help. The Health Protection Surveillance Centre is responsible for collecting details of notifiable diseases. The full list of notifiable diseases can be found on their website, www.hpsc.ie


Deaths Where a death occurs suddenly or unexpectedly or from a cause that is unknown, unclear or unnatural, it must be reported to the coroner. The coroner will not be involved where a person died from some natural illness or disease for which they were treated by a doctor within one month prior to death. In this case, doctors can issue the medical certificate of the cause of death and the death can be registered. It is always worth calling the coroner for advice – have the coroner’s number programmed into your mobile phone in case of emergencies, www.coroner.ie


CONFIDENTIALITY


GP TRAINEE | VOLUME 5 | ISSUE 2 | 2012 | IRELAND www.medicalprotection.org


© MONTY RAKUSEN 2008


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