confidentiality toby l. schonfeld, ph.d. department of preventive and societal medicine...
TRANSCRIPT
ConfidentialityConfidentiality
Toby L. Schonfeld, Ph.D.Toby L. Schonfeld, Ph.D.Department of Preventive and Societal Department of Preventive and Societal
[email protected]@unmc.edu
What’s at stakeWhat’s at stake
What confidentiality isWhat confidentiality is
How it is promoted by professionsHow it is promoted by professions
Why confidentiality is importantWhy confidentiality is important
Justified instances of disclosureJustified instances of disclosure
Types of sanctionsTypes of sanctions
How do we navigate difficult cases?How do we navigate difficult cases?
Confidentiality is...Confidentiality is...
““A socially publicizable and enforceable A socially publicizable and enforceable pledge to keep secret or hold in pledge to keep secret or hold in confidence any information about the confidence any information about the client which is gained by the professional client which is gained by the professional during the normal course of client-during the normal course of client-professional interactions.”professional interactions.”– Rem B. Edwards, “Confidentiality and the Rem B. Edwards, “Confidentiality and the
Professions,” Bioethics (.....)Professions,” Bioethics (.....)
Specific Statements ofSpecific Statements ofProfessional PromotionProfessional Promotion
Nuclear Medicine Code of Ethics Nuclear Medicine Code of Ethics
Principle III:Principle III:““The Nuclear Medicine Technologist will The Nuclear Medicine Technologist will maintain strict patient confidentiality in maintain strict patient confidentiality in accordance with state and federal accordance with state and federal regulations.” regulations.”
Specific Statements of Specific Statements of Professional PromotionProfessional Promotion
American Dietetic Association American Dietetic Association Code of EthicsCode of Ethics
Principle IV:Principle IV:
““The dietetic practitioner maintains The dietetic practitioner maintains confidentiality of information.confidentiality of information. “ “
American Society of Radiologic American Society of Radiologic TechnologistsTechnologists
““The radiologic technologist respects The radiologic technologist respects confidences entrusted in the course of confidences entrusted in the course of professional practice, respects the professional practice, respects the patient's right to privacy and reveals patient's right to privacy and reveals confidential information only as required confidential information only as required by law or to protect the welfare of the by law or to protect the welfare of the individual or the community. “individual or the community. “
Why keep patient information Why keep patient information confidential?confidential?
Fundamental human values
Rules of Confidentiality
Professional behavior
Why keep patient information confidential? Why keep patient information confidential? (1) Privacy(1) Privacy
Information about ourselves we do not Information about ourselves we do not want disclosed to otherswant disclosed to others– General:General:
Physical factsPhysical facts
Mental factsMental facts
Behavioral factsBehavioral facts
– SpecificSpecific
Risks associated with the violation of Risks associated with the violation of privacyprivacy
Why keep patient information confidential? Why keep patient information confidential? (2) Social Status(2) Social Status
Confidentiality affirms and protects the Confidentiality affirms and protects the social status of the clientsocial status of the client– Marginalized groupsMarginalized groups– Stigmatizing conditionsStigmatizing conditions– Community membersCommunity members
Why keep patient information confidential? Why keep patient information confidential? (3) Economic Advantage(3) Economic Advantage
Confidentiality is economically Confidentiality is economically advantageous to the patientadvantageous to the patient– Economic stigmatizationEconomic stigmatization
Why keep patient information confidential? Why keep patient information confidential? (4) Open Communication(4) Open Communication
Confidentiality promotes open Confidentiality promotes open communication between provider-patientcommunication between provider-patient– Encourages patients to disclose intimate Encourages patients to disclose intimate
detailsdetails– Violations of confidentiality cause patients to Violations of confidentiality cause patients to
withhold essential informationwithhold essential information
Why keep patient information confidential? Why keep patient information confidential? (5) Seeking help(5) Seeking help
Confidentiality encourages patients to Confidentiality encourages patients to seek professional help.seek professional help.– Open communication first requires the patient Open communication first requires the patient
to come to the officeto come to the office– Studies show that seeking help is a Studies show that seeking help is a
cost/benefit analysis: professional service cost/benefit analysis: professional service gains vs. confidentiality lossesgains vs. confidentiality losses
Why keep patient information confidential? Why keep patient information confidential? (6) Trust(6) Trust
Trust: confidence that we can depend on Trust: confidence that we can depend on the competence, integrity, support, care, the competence, integrity, support, care, and concern of anotherand concern of another
– ABIM Charter: commitment to professional ABIM Charter: commitment to professional competencecompetence
– Violation of trust results in contempt, deep Violation of trust results in contempt, deep alienation, suspicionalienation, suspicion
Why keep patient information confidential? Why keep patient information confidential? (7) Promotes autonomy(7) Promotes autonomy
Autonomy: capacity for making decisionsAutonomy: capacity for making decisions
HIPAA: information is in the control of the HIPAA: information is in the control of the patientpatient
Principle of patient autonomy: CharterPrinciple of patient autonomy: Charter
DisclosureDisclosure
““Need to know” information Need to know” information
Sometimes we have other values that will Sometimes we have other values that will conflict with our value of confidentialityconflict with our value of confidentiality
DisclosureDisclosure
Legitimate breaches of confidentiality must Legitimate breaches of confidentiality must consider the following points: consider the following points: – There is no less costly way of promoting the There is no less costly way of promoting the
competing valuescompeting values– The conflicting value will be significantly The conflicting value will be significantly
advanced by violating confidentialityadvanced by violating confidentiality– Competing value is more important than the 7 Competing value is more important than the 7
confidentiality valuesconfidentiality values
Specifics of disclosureSpecifics of disclosure
When are breaches acceptable or When are breaches acceptable or required?required?– Violent wound reportsViolent wound reports– Suspicion of abuse or neglectSuspicion of abuse or neglect– Danger to self or othersDanger to self or others– Communicable diseasesCommunicable diseases
SanctionsSanctions
Moral sanction: conscienceMoral sanction: conscience
Social sanction: public opinionSocial sanction: public opinion
Legal sanction: positive law and means of Legal sanction: positive law and means of enforcementenforcement
Now back to the case...Now back to the case...
OptionsOptions
Recommend that Al inform his partnerRecommend that Al inform his partnerFacilitation of disclosureFacilitation of disclosureRisk reductionRisk reductionExplore Al’s valuesExplore Al’s valuesCall the health departmentCall the health departmentSet time limit for Al’s disclosure to partnerSet time limit for Al’s disclosure to partnerDismiss Al from your practiceDismiss Al from your practiceDisclose risk to Al’s partnerDisclose risk to Al’s partner
Competing valuesCompeting values
Privacy rights of Al vs. autonomy rights of Privacy rights of Al vs. autonomy rights of partnerpartner
Autonomy rights of partner vs. risk to Autonomy rights of partner vs. risk to physician-patient relationshipphysician-patient relationship
Responsibility to patient vs. responsibility Responsibility to patient vs. responsibility to publicto public
Criteria for breaching confidentialityCriteria for breaching confidentiality
Is the burden met here?Is the burden met here?– Alternatives to disclosureAlternatives to disclosure– Which “conflicting values” will be advanced?Which “conflicting values” will be advanced?– Are these values more important than the 7 Are these values more important than the 7
fundamental values?fundamental values?