Avoiding Medical Malpractice - Privacy and Confidentiality

Another area in which ethical and legal problems may arise is in questions of Privacy and Confidentiality.
Privacy refers to a state of "limited access to a person". Put simply, privacy is the right to be left alone. 

For example: A woman consents for her physician to check her HLA type for a hospital laboratory study. Years later, a hospital administrator develops leukemia and requires a bone marrow transplant. He searches hospital records for someone who is HLA compatible and finds that the woman is a perfect match. He contacts her and her physician repeatedly, despite her expressed disinterest in donating marrow. Eventually she sues the administrator for invasion of privacy. 

While someone who gains access to medical records or other information without consent may be guilty of invasion of privacy, the person who grants access to a third person without consent is guilty of a breach of confidentiality. For example, if the woman's physician in the above example had given access to her medical information to the hospital administrator, that physician would be guilty of a breach of confidentiality. The rules of confidentiality prohibit disclosure of information to third parties without the consent of the original source of information. And, since physicians are routinely in receipt of confidential information which is often shared with others in the course of patient diagnosis and management, they are frequently at risk of breaching the confidentiality of patients. 

Another example of breach of confidentiality: A group of post-call residents are discussing admissions from the previous night while riding the public elevator down to breakfast. One resident names and discusses an HIV + patient admitted with pneumonia. Unknown to him, the patients family are among the riders of the elevator. Later, the family writes the hospital, complaining breach of confidentiality.

Informed Consent

The final element of patient autonomy that we will explore is informed consent. While it is possible to fulfill the legal standard of informed consent with a completed, dated and signed consent form, true informed consent requires a number of elements:

• that the patient is competent;
• that appropriate information is presented to the patient by the provider;
• that the patient understand the material presented by the provider;
• that the patient acts voluntarily (without coercion or under duress) and
• that the patient agree to the plan presented.