Confidentiality and the Management of Health Care Information

Personal privacy appears to be under seige  in all aspects of our lives. The use of computers has greatly increased this concerns, as it i common knowledge that all of us have dossiers in several major data banks. These governmental and commercial data sources provide information to others in regard to credit ratings, marital status, and even hobbies and interests. It seems at times that one need only provide a small donation to a favorite charity (perhaps to save woodlands) before being inundated by an avalanche  of offers for the type of person who might want to save woodlands, or at least look woodsy.

The general patient population still places a great deal of faith in the manner in which health care providers maintain the principle of confidentiality. Confidentiality seems to serve two basic purposes. First, the principle acknowledges a respect for the individuals right to privacy as guaranteed by our legal system and enshrined in our cultural values. Second, and perhaps more important to the health of the patient, the promise of confidentiality provides a bond between the practitioner and patient that allows for a full and honest disclosure of information. In those rare cases where disclosure  is necessary to protect a community interest, confidentiality must be balanced by a duty to warn, especially with vulnerable third parties.

Although the establishment of hospital team medicine and bureaucratic information has eroded the principle of confidentiality, it is imperative that, to the fullest possible extent, health care providers take meticulous care to guarantee that patient’s medical and personal information be kept confidential. To the degree that health care providers must breach confidentiality to third parties, it would seem that the patient should be notified of the  nature and ramifications of these disclosures. If patients understands what will happen to the information, they then would be in better positions to decide which of their personal matters they would choose to relate and what they would prefer to keep private.

Policies must be designed to balance the right to legitimate personal privacy while not offsetting the institutional need to make necessary information quickly and easily available to those who have a legitimate claim to it. It would seem that, at a minimum, these privacy safeguards should ;

  1. ) Define circumstances under which medical information is disclosed to other parties.
  2. ) Provide procedures by which patients may gain access to their records.
  3. ) Allow access to records to other only on a “need to know” basis.
  4. ) Ensure anonymity in aggregating data for research or statistical purposes.
  5. ) Carefully balance societies long term goals and the legitimate need of organizations to have access to medical records with the patient’s short term desire for and right  to privacy.
  6. )  Inform the patient to what is meant by confidentiality in the context of current practice.

These safeguards would be in the spirit of informed consent and would offer some protection against misuse and abuse of patient information. In addition, if patients have access to their records, they can ensure that the information contained there is accurate, complete, and relevant to their care. Patient advocacy is a significant responsibility of all health care practitioners, and the restoration of some semblance of institutional responsibility in the area of confidentiality is necessary if our patients are to continue to believe in the process.

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