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Introduction
<div class="editorbox"> '''Original Editor '''- [[User:Robin Tacchetti|Robin Tacchetti]] based on the course by [https://members.physio-pedia.com/course_tutor/jason-giesbrecht/ Jason Giesbrecht]<br>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


Confidentiality refers to the restriction of access to personal information from unauthorized persons and processes at authorized times and in an authorized manner [1, 2]. When we say patients have the right to confidentiality, it refers to keeping privileged communication secret and cannot be disclosed without the patient’s authorization <ref name=":0">Tegegne, M.D., Melaku, M.S., Shimie, A.W., Hunegnaw, D.D., Legese, M.G., Ejigu, T.A., Mengestie, N.D., Zemene, W., Zeleke, T. and Chanie, A.F., 2022. [https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-022-00765-0 Health professionals' knowledge and attitude towards patient confidentiality and associated factors in a resource-limited setting: a cross-sectional study]. BMC Medical Ethics, 23(1), p.26. <nowiki>https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-022-00765-0</nowiki></ref>


Health professionals have a legal obligation to handle patients' information privately and securely [5]. As a result, patients and professionals develop trust and a positive relationship. If such highly sensitive data is improperly disclosed, it could threaten patients' safety [6]. Hence confidentiality needs to be respected to protect patients’ well-being and maintain society’s trust in the physician–patient relationship. <ref name=":0" />


Confidentiality is the basis of the legal elements of health records and an ethical cornerstone of excellent care [11]. More importantly, the quality of information shared with healthcare experts is determined by their capacity to keep it private. Otherwise, the patient may withhold important information, lowering the quality of care offered.<ref name=":0" />
== Introduction ==
Privacy, autonomy and confidentiality are interrelated concepts that are crucial to rehabilitation practice. Privacy refers to an individual’s right to control access to their personal information. Autonomy conveys an individual’s right to make decisions about their treatment and care. Both privacy and autonomy are closely related as they involve an individual’s control over their own information and choices. Confidentiality signifies the obligation to keep personal information private and secure in accordance with legal and ethical principles.<ref name=":3">Giesbrecht, J. Principles of Confidentiality and Informed Consent.  Plus 2023</ref>


Although information sharing is essential in an interdisciplinary health team, each professional should limit information disclosure to an unauthorized health professional to plan and carry out procedures in the patient's best interests [12]. The exchange of patient medical records and data with an unauthorized person continues to be a common occurrence in a variety of clinical settings [5]. Breaches of confidentiality in clinical practice due to negligence, indiscretion, or sometimes even maliciously jeopardize a duty inherent in the physician–patient relationship [8]. Breaches of confidentiality and sharing data with unauthorized parties may have the potential to harm the patients’ health [13]. Health care quality declines due to a loss of confidence in the professional-patient relationship [14]. Patients become hesitant to seek care and attend follow-up appointments due to their mistrust of health providers <ref name=":0" />
== Maintaining Confidentiality ==
Confidentiality is not only about keeping information private. It also involves taking steps to ensure that information is secure and protected from unauthorised users. There are a number of ways healthcare providers can prevent electronic breaches in confidentiality:


* Electronic records:
** use password protection
** store securely
** have protocols in place to prevent unauthorised access
** use encryption
** maintain regular backups
** secure deletion of records when they are no longer required
** have periodic audits to make sure records are being accessed appropriately and to detect any unauthorised users
* Mobile devices:
** use password protection
** remote wipe capabilities in a situation where mobile devices are lost or stolen<ref name=":3" />


Healthcare professionals are ethically obligated to maintain a patient’s privacy and protect their autonomy.<ref name=":0">Tegegne, M.D., Melaku, M.S., Shimie, A.W., Hunegnaw, D.D., Legese, M.G., Ejigu, T.A., Mengestie, N.D., Zemene, W., Zeleke, T. and Chanie, A.F., 2022. [https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-022-00765-0 Health professionals' knowledge and attitude towards patient confidentiality and associated factors in a resource-limited setting: a cross-sectional study]. BMC Medical Ethics, 23(1), p.26. <nowiki>https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-022-00765-0</nowiki></ref>  <ref name=":2">Wadmann S, Hartlev M, Hoeyer K. [https://link.springer.com/article/10.1057/s41292-021-00269-x The life and death of confidentiality: a historical analysis of the flows of patient information.] Biosocieties. 2022 Jan 29:1-26.  </ref> Within all communication including written, verbal, electronic or virtual the highest standards should be maintained with regards to informed consent and confidentiality.<ref>[https://scota.net/resources/Documents/AOTA%202020%20Code%20of%20Ethics.pdf AOTA 2020 Occupational Therapy Code of Ethics]. American Journal of Occupational Therapy. 2020 Nov;74:3.</ref> Keeping patient information confidential is not just an ethical issue but also a legal one in many countries. Maintaining confidentiality protects patients from negative outcomes such as ruining personal relationships, employment discrimination and insurance coverage issues.<ref name=":3" />


Physicians are obligated not to disclose confidential information given by a patient to another party without the patient’s authorization. An obvious exception (with implied patient authorization) is the sharing necessary of medical information for the care of the patient from the primary physician to consultants and other health-care teams. In the present-day modern hospitals with multiple points of tests and consultants, and the use of electronic medical records, there has been an erosion of confidentiality. However, individual physicians must exercise discipline in not discussing patient specifics with their family members or in social gatherings [24] and social media. There are some noteworthy exceptions to patient confidentiality. These include, among others, legally required reporting of gunshot wounds and sexually transmitted diseases and exceptional situations that may cause major harm to another (e.g., epidemics of infectious diseases, partner notification in HIV disease, relative notification of certain genetic risks, etc.).<ref>Varkey B. [https://karger.com/mpp/article/30/1/17/204816/Principles-of-Clinical-Ethics-and-Their Principles of clinical ethics and their application to practice.] Medical Principles and Practice. 2021;30(1):17-28. </ref>
Respecting confidentiality demonstrates the provider's commitment to the patient's well-being. In addition, it builds trust, permitting the patient to disclose sensitive information to their provider.<ref name=":0" /><ref name=":2" /> If patients do not trust their provider and withhold relevant information, the quality of care and outcomes will decrease.<ref name=":0" />


There are a few situations where maintaining patient confidentiality is not possible, including:


Barriers
# When there is a risk of harm to the patient or others
# Exceptional situations that may cause major harm to others, including
#* partner notification in HIV disease
#* epidemics of infectious diseases
#* relative notification of certain genetic risks
# When a health worker is legally required to report information, such as:
#* gunshot wounds
#* sexually transmitted diseases<ref name=":3" /><ref name=":4">Varkey B. [https://karger.com/mpp/article/30/1/17/204816/Principles-of-Clinical-Ethics-and-Their Principles of clinical ethics and their application to practice.] Medical Principles and Practice. 2021;30(1):17-28. </ref>


Therefore, physicians are ethically and legally obliged to maintain their patients’ data privacy and protect their autonomy.<ref name=":1">Karasneh R, Al-Mistarehi AH, Al-Azzam S, Abuhammad S, Muflih SM, Hawamdeh S, Alzoubi KH. [https://www.tandfonline.com/doi/full/10.2147/IJGM.S301800 Physicians’ knowledge, perceptions, and attitudes related to patient confidentiality and data sharing.] International Journal of General Medicine. 2021 Mar 2:721-31. <nowiki>https://www.tandfonline.com/doi/full/10.2147/IJGM.S301800</nowiki></ref>
== Breaches of Confidentiality ==
Breaches of confidentiality can be accidental, intentional or have systemic causes. Accidental breaches may occur from technical malfunctions, human error, inadequate training or lack of awareness about the importance of confidentiality. Intentional breaches are acts performed by individuals seeking personal gain. They can be committed by insiders, hackers or unauthorised individuals. Insiders can be motivated by personal reasons or financial gain, while outsiders may be driven by political reasons, financial gain or other factors. Finally, systemic breaches can occur when there are inadequate security measures or insufficient protocols for managing confidential information.<ref name=":3" />


4 However, sharing patients data with unauthorized people still frequently occur in different clinical settings and departments and, unfortunately, involve most healthcare personnel.<ref name=":1" />
Confidential breaches commonly occur in the following ways:


6 These breaches include disclosing patient data to third parties, discussing patient information in public areas, incorrectly disposing of patient records, leaving electronic or paper health records unattended, and providing care with open doors.<ref name=":1" />
* Healthcare professionals discussing patient information in public areas
* Healthcare professionals discussing patient information with their family
* Leaving electronic or paper health records unattended
* Incorrectly disposing of patient records
* Providing care with open doors
* Disclosing patient data to third parties<ref name=":2" /><ref name=":1">Karasneh R, Al-Mistarehi AH, Al-Azzam S, Abuhammad S, Muflih SM, Hawamdeh S, Alzoubi KH. [https://www.tandfonline.com/doi/full/10.2147/IJGM.S301800 Physicians’ knowledge, perceptions, and attitudes related to patient confidentiality and data sharing.] International Journal of General Medicine. 2021 Mar 2:721-31. <nowiki>https://www.tandfonline.com/doi/full/10.2147/IJGM.S301800</nowiki></ref>


Concerns about sharing patients data with unauthorized people by physicians may have undesirable effects on patients’ health. Breaches of confidentiality may lead to foregone healthcare, making healthcare seekers more likely to engage in dangerous behaviors or report psychological problems.<ref name=":1" />
== Consequences of Breaches of Confidentiality ==
Breaches in confidentiality can have negative consequences on the provider-patient relationship. When confidential information is leaked, the patient loses trust in their provider. As the relationship deteriorates, the patient may be hesitant to seek help, attend follow-up visits or disclose information necessary to establish an efficient treatment plan, which may lead to negative outcomes.<ref name=":0" /><ref name=":3" /> <ref name=":2" />


9 Likewise, as these concerns may diminish patient’s trust in their physicians, patients may hesitate to seek help, attend follow-up appointments, or even disclose essential information for the establishment of an efficient healthcare plan.<ref name=":1" />
Confidential breaches can also have negative consequences for healthcare providers. Healthcare professionals can be held liable for breaches in the form of fines, lawsuits and criminal charges. If the breach becomes public knowledge, the provider's, and their organisation's, reputation can be damaged. This can lead to loss of business and difficulty in finding a job in the future.<ref name=":3" /> The healthcare professional can also be investigated and fined/suspended by their country or state professional board. 


These confidentiality concerns have been acknowledged as being global concerns. Therefore, various internationally agreed recommendations and guidelines that appl<ref name=":1" />
<nowiki>**</nowiki>If a breach does occur, it is important to report it immediately and take steps to mitigate any potential harm.<ref name=":3" />


== Resources ==


ortunately, this confidentiality is frequently breached in different ways (Beltran-Aroca, Girela-Lopez, Collazo-Chao, Montero-Perez-Barquero and Munoz-Villanueva, 2016; Hartigan, Cussen, Meaney and O'Donoghue, 2018; Kerr, Lu and McKinlay, 2014; Koivula-Tynnila, Axelin and Leino-Kilpi, 2018), for example due to indiscretion or carelessness when speaking about a patient on the phone or in a public area (Beltran-Aroca, Girela-Lopez, Collazo-Chao, Montero-Perez-Barquero and Munoz-Villanueva, 2016). The physical hospital environment has also been identified as an issue that may compromise patient confidentiality as it can be difficult to ensure confidentiality during rounds in multi-patient rooms (Kerr, Lu and McKinlay, 2014). The consequences of such breaches of confidentiality include patients withholding information about themselves or being embarrassed when they hear things about others (Koivula-Tynnila, Axelin and Leino-Kilpi, 2018). Furthermore, avoiding such breaches can be particu<ref>Eg M, Jensen CS. [https://www.pediatricnursing.org/article/S0882-5963(22)00332-3/fulltext The challenges of maintaining patient confidentiality in pediatric settings]. Journal of Pediatric Nursing. 2023 Mar 1;69:18-23.  </ref>
* [[Informed Consent]]
* [[Informed Consent With People Who Have Dementia]]
* [https://www.physio-pedia.com/Section_8:_Informed_consent_and_medico-legal_framework Section 8: Informed consent and medico-legal framework]
* [https://scota.net/resources/Documents/AOTA%202020%20Code%20of%20Ethics.pdf AOTA 2020 Occupational Therapy Code of Ethics]
* [https://www.apta.org/siteassets/pdfs/policies/codeofethicshods06-20-28-25.pdf APTA 2020 Code of Ethics for the Physical Therapist]


Many of the problems that make patients go to see a doctor are delicate ones. They involve confiding potentially embarrassing pieces of information to a professional who might be a complete stranger. Geissler (2013) and Jones (2014) have argued that what counts as sensitive information differs between individuals and varies between societies. Surveys among European populations suggest that issues related to sexuality, substance abuse, and mental health are typically considered particularly sensitive (Larsen et al. 2019). To confide such information to others not only presupposes a particular form of relationship—it generates it. To reveal intimate information involves an intricate social dynamic between people (Fainzang 2002). Simmel summarized this in his seminal analysis of secrets:<ref name=":2">Wadmann S, Hartlev M, Hoeyer K. [https://link.springer.com/article/10.1057/s41292-021-00269-x The life and death of confidentiality: a historical analysis of the flows of patient information.] Biosocieties. 2022 Jan 29:1-26.  </ref>
== References ==
 
<references />
the trust we receive contains an almost compulsory power, and to betray it requires thoroughly positive meanness. By contrast, confidence is ‘given’; it cannot be requested in the same manner in which we are requested to honour it, once we are its recipients (Simmel 1950a, p. 348).<ref name=":2" />
[[Category:Rehabilitation]]
 
[[Category:ReLAB-HS Course Page]]
The handling of patient information matters to—and works upon—those who need to confide in health professionals, as well as those professionals who come to act as guardians of other people’s secrets. ‘Secrecy’ refers to a social expectation of unconditional withholding of information in a relationship between people. ‘Confidentiality’ also pertains to a relationship between people, but the withholding of information is not unconditional. Rather, confidentiality refers to a regulated flow of information: information is conveyed to others only according to an agreement, or to predefined rules. These rules can be compared to what Nissenbaum has described as tacit and “context-relative informational norms” relating to actors (who receives information), attributes (types of information), and transmission principles (constraints on flows) (Nissenbaum 2010, pp.140–147). As long as these rules correspond to patient expectations, a transfer of information—e.g. among health professionals—is not privacy infringement.<ref name=":2" />
[[Category:Administration]]
 
[[Category:Course Pages]]
2 Confidentiality implies that the health professional in whom the patient confides curates the information, which is to be passed on. Curation, in this sense, refers to a “discriminate selection” of information in order to control what is shared with whom (Davis 2017, p. 773). Johansen and Andrews (2016) have suggested that without such curation, patients might not feel confident to entrust professionals the information that is needed to identify the correct diagnosis and commence adequate treatment.<ref name=":2" />
 
The ability of health professionals to control the flow of patient information has changed over time. Nearly fifty years ago—at a time when doctors were mostly men and technological options for information sharing were more limited—Grossman (1977) pointed to how the political ambition of mitigating societal risks interacted with legal requirements, and prompted doctors to consider how to balance a concern for confidentiality with the duties of reporting:<ref name=":2" />
 
For his (sic) patients’ sake and increasingly for his own as well, the physician would be well advised to learn the narrow but tortuous path between the edict ‘reveal not your patients’ data’ and growing demands that he do just that (Grossman 1977, p. 43).<ref name=":2" />
 
Since then, information generation, storage and exchange has changed radically along with the ever more pervasive digitalization and the changing political and legal frameworks. It is through these changes in the political, legal and technological conditions for information storage and exchange that we identify the ‘life a<ref name=":2" />

Latest revision as of 23:09, 31 August 2023

Original Editor - Robin Tacchetti based on the course by Jason Giesbrecht
Top Contributors - Robin Tacchetti, Jess Bell, Tarina van der Stockt and Kim Jackson


Introduction[edit | edit source]

Privacy, autonomy and confidentiality are interrelated concepts that are crucial to rehabilitation practice. Privacy refers to an individual’s right to control access to their personal information. Autonomy conveys an individual’s right to make decisions about their treatment and care. Both privacy and autonomy are closely related as they involve an individual’s control over their own information and choices. Confidentiality signifies the obligation to keep personal information private and secure in accordance with legal and ethical principles.[1]

Maintaining Confidentiality[edit | edit source]

Confidentiality is not only about keeping information private. It also involves taking steps to ensure that information is secure and protected from unauthorised users. There are a number of ways healthcare providers can prevent electronic breaches in confidentiality:

  • Electronic records:
    • use password protection
    • store securely
    • have protocols in place to prevent unauthorised access
    • use encryption
    • maintain regular backups
    • secure deletion of records when they are no longer required
    • have periodic audits to make sure records are being accessed appropriately and to detect any unauthorised users
  • Mobile devices:
    • use password protection
    • remote wipe capabilities in a situation where mobile devices are lost or stolen[1]

Healthcare professionals are ethically obligated to maintain a patient’s privacy and protect their autonomy.[2] [3] Within all communication including written, verbal, electronic or virtual the highest standards should be maintained with regards to informed consent and confidentiality.[4] Keeping patient information confidential is not just an ethical issue but also a legal one in many countries. Maintaining confidentiality protects patients from negative outcomes such as ruining personal relationships, employment discrimination and insurance coverage issues.[1]

Respecting confidentiality demonstrates the provider's commitment to the patient's well-being. In addition, it builds trust, permitting the patient to disclose sensitive information to their provider.[2][3] If patients do not trust their provider and withhold relevant information, the quality of care and outcomes will decrease.[2]

There are a few situations where maintaining patient confidentiality is not possible, including:

  1. When there is a risk of harm to the patient or others
  2. Exceptional situations that may cause major harm to others, including
    • partner notification in HIV disease
    • epidemics of infectious diseases
    • relative notification of certain genetic risks
  3. When a health worker is legally required to report information, such as:
    • gunshot wounds
    • sexually transmitted diseases[1][5]

Breaches of Confidentiality[edit | edit source]

Breaches of confidentiality can be accidental, intentional or have systemic causes. Accidental breaches may occur from technical malfunctions, human error, inadequate training or lack of awareness about the importance of confidentiality. Intentional breaches are acts performed by individuals seeking personal gain. They can be committed by insiders, hackers or unauthorised individuals. Insiders can be motivated by personal reasons or financial gain, while outsiders may be driven by political reasons, financial gain or other factors. Finally, systemic breaches can occur when there are inadequate security measures or insufficient protocols for managing confidential information.[1]

Confidential breaches commonly occur in the following ways:

  • Healthcare professionals discussing patient information in public areas
  • Healthcare professionals discussing patient information with their family
  • Leaving electronic or paper health records unattended
  • Incorrectly disposing of patient records
  • Providing care with open doors
  • Disclosing patient data to third parties[3][6]

Consequences of Breaches of Confidentiality[edit | edit source]

Breaches in confidentiality can have negative consequences on the provider-patient relationship. When confidential information is leaked, the patient loses trust in their provider. As the relationship deteriorates, the patient may be hesitant to seek help, attend follow-up visits or disclose information necessary to establish an efficient treatment plan, which may lead to negative outcomes.[2][1] [3]

Confidential breaches can also have negative consequences for healthcare providers. Healthcare professionals can be held liable for breaches in the form of fines, lawsuits and criminal charges. If the breach becomes public knowledge, the provider's, and their organisation's, reputation can be damaged. This can lead to loss of business and difficulty in finding a job in the future.[1] The healthcare professional can also be investigated and fined/suspended by their country or state professional board.

**If a breach does occur, it is important to report it immediately and take steps to mitigate any potential harm.[1]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Giesbrecht, J. Principles of Confidentiality and Informed Consent. Plus 2023
  2. ↑ 2.0 2.1 2.2 2.3 Tegegne, M.D., Melaku, M.S., Shimie, A.W., Hunegnaw, D.D., Legese, M.G., Ejigu, T.A., Mengestie, N.D., Zemene, W., Zeleke, T. and Chanie, A.F., 2022. Health professionals' knowledge and attitude towards patient confidentiality and associated factors in a resource-limited setting: a cross-sectional study. BMC Medical Ethics, 23(1), p.26. https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-022-00765-0
  3. ↑ 3.0 3.1 3.2 3.3 Wadmann S, Hartlev M, Hoeyer K. The life and death of confidentiality: a historical analysis of the flows of patient information. Biosocieties. 2022 Jan 29:1-26. 
  4. ↑ AOTA 2020 Occupational Therapy Code of Ethics. American Journal of Occupational Therapy. 2020 Nov;74:3.
  5. ↑ Varkey B. Principles of clinical ethics and their application to practice. Medical Principles and Practice. 2021;30(1):17-28.
  6. ↑ Karasneh R, Al-Mistarehi AH, Al-Azzam S, Abuhammad S, Muflih SM, Hawamdeh S, Alzoubi KH. Physicians’ knowledge, perceptions, and attitudes related to patient confidentiality and data sharing. International Journal of General Medicine. 2021 Mar 2:721-31. https://www.tandfonline.com/doi/full/10.2147/IJGM.S301800
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