Topic and thesis

Doctors, nurses, clinicians and every other person who provide care to a patient become entrusted with the patients’ health information.  Patients routinely provide health care providers with personal information regarding their health. This information should be used only in service for the patient. The health care providers are thus entrusted with an ethical responsibility to maintain the patient’s privacy and confidentiality. However, dilemmas may occur when friends or family members of the patient request this confidential information. The ethical basis of confidentiality lies in the Hippocratic Oath where the healthcare providers swear to keep confidential, the information they get from patients.  The thesis of this paper is to analyze the legal and ethical issues surrounding patient confidentiality.

According to McGowan, nurses encounter numerous ethical and legal duties while performing their professional role. It is crucial that they maintain the patient’s privacy and confidentiality per the Nightingale Pledge where the nurses pledge to elevate the standards of the nursing profession. They also promise to maintain their confidence in matters relating to their practice. Nurses are therefore encouraged to act within this pledge and are expected to be accountable for their actions. Notable policies have been enacted to protect the patient’s confidentiality. Some of these policies include; the Health Insurance Portability and Accountability Act, Human rights act 1996, mental capacity act 2005, and the data protection act.

The Health insurance and Portability Act was enacted to enable the continuity of health insurance coverage and make it easier to administer health insurance. The provision of insurance was to be done per the Privacy Rule which aims at assuring the protection of an individual’s health information while allowing the flow of health information needed to provide and promote quality healthcare. The privacy rule permits the sharing of a patient’s information only under the following circumstances; when the information is being shared to the individual who is the subject of the information. Secondly, a patient’s protected health information may be shared for the treatment, payment and healthcare operations activities. A patient is to be consulted whether their private information is to be shared. The mental capacity act 2005 empowers clinicians and nurses to provide this information in cases where the patient may be incapacitated. Providers may use and disclose an individual’s health information when the information is meant for public health and benefit activities.

There are also cases where there may be inappropriate use or disclosure of protected health information. These cases occur when the health information is provided to an individual who is not involved in the patient’s treatment and care. Inappropriate use or disclosure of the protected health information may also arise when the information is divulged against the best interests of the patient. In some cases the disclosure of a patient’s protected information may be unintentional, for instance, emailing of data relating to a patient to a wrong recipient or a healthcare provider discussing the details with a colleague not involved in the patient’s care.

Challenges to maintaining a patient’s confidentiality

Healthcare providers face the challenges of maintaining the balance between personal protection and efficient delivery of healthcare. There has often been confusion and misinterpretation of the privacy rule. There are several instances where a patient’s confidentiality may be compromised. Such cases are referred to as inadvertent disclosure. Examples of such situations are;

• Ward communications with colleagues

This type of breach to patient’s health information occurs during phone consultations where people around the healthcare provider can easily hear the conversations. Violations to patient confidentiality have also been reported in corridor conversations, during ward rounds, especially in multi-bed bays.

This breach in patient confidentiality can be averted by having conversations and discussions in enclosed spaces such as offices. The layout at the reception should also be re-arranged to prevent unauthorized access to files at the reception.  Sensitive phone conversations should also be discouraged between patients and healthcare providers. In multi-bed bays, healthcare providers can always draw the curtains around the patient and speak quietly.

• Communication with relatives

The privacy act prohibits the sharing of privileged information to third parties including the patient’s relatives. Most health care providers often divulge details about a patient’s health condition to relatives without the patient’s consent. The privacy act demands that the nurse should first seek the permission of the patient regarding the sharing of this information. However, for the cases of patients in dementia or unconscious patients in the intensive care unit, the decision to divulge this information will be based on the mental capacity act 2005.  The act directs that the health care provider acts in the patient’s best interests. In such cases, the health care provider is at liberty to inform the relatives of the patient’s condition unless the patient had instructed that the information should not be disclosed.

• Computers

Many health institutions use computers for data entry and the transfer of the information relating to patients to and from various departments in the hospital. Nurses and healthcare providers are instructed to ensure that person-identifiable details are encrypted before they are transferred. The passwords to the computers are to be kept secure and changed regularly. Healthcare providers advised to log off, especially, on computers in ‘public’ places to ensure that personal protected do not get into unauthorized hands.

• E-mail communication

Health care institutions are advised to develop an approved e-mail service for securely exchanging clinical data between the hospital staff.  The creations of such email platforms will ensure that patient identification data and other sensitive information are emailed to other members of staff are secure. However, emails sent outside these platforms are unencrypted, and the healthcare provider becomes responsible for the implications against this breach of confidentiality.

Conclusion

In conclusion, patient confidentiality is essential in the development of the trust between a doctor and a patient. Healthcare providers are therefore obligated to protect the confidential information about their patients. The various legal and regulating policies governing confidentiality put in place are meant to ensure that the patient’s protected information is protected. Breaches of doctor-patient privacy, therefore, have legal implications. Healthcare providers, therefore, should maintain their confidentiality with their patients. However, when this breach of confidentiality occurs inadvertently, the healthcare provider should be able to prove that appropriate measures were taken to prevent the privacy breach from happening.