A lecture on privacy, confidentiality and medical records delivered to Alfarabi Medical College undergraduate medical students in the week starting 27.11.2016

1. Professionalism and Ethics Education for Residents (PEER)
Privacy, Confidentiality and
Medical Records
Dr. Ghaiath M. A. Hussein
Asst. Prof., Dept. of Medical Ethics
Alfarabi Colleges (Riyadh)

2. Disclaimer
• This presentation is based on a presentation I
gave for the SCHS as part of its
Professionalism and Ethics Education for
Residents (PEER), available at:
https://www.youtube.com/watch?v=b-
7DOqRPqx0
• https://www.youtube.com/watch?v=OcQYe99
SwSo

3. Outline
 Definitions and differences
 How to maintain the privacy of our patients?
 How to maintain the confidentiality of our patients’
information?
 When to disclose medical information

4. Privacy and Confidenciality?
EXERCISE….

5. Confidentiality :
- Is the right of an individual
to have personal,
identifiable medical
information kept out of
reach of others.
Privacy:
- A right or expectation to
not be interfered with
- Be free from surveillance
- A moral right to be left
alone.
RESPECTS PATIENT’S
BODY
RESPECTS PATIENT’S
INFORMATION

6. PRIVACY

7. Measures to Protect Privacy
(KSA guidelines)
1. Make sure examination takes place in isolation from other
patients, unauthorized family members, and/or staff
2. Provide gender-sensitive waiting and examination rooms
3. Provide proper clothing for the admitted patients
4. Make sure patients are well covered when transferred from
one place to another in the hospital
5. Make sure your patient’s body is exposed ONLY as much as
needed by the examination or investigation
6. Patients should have separate lifts and be given priority

8. Measures to Protect Privacy
(KSA guidelines)
1. Make sure there is another person (nurse) of the same sex as the
patient present all the time of the examination
2. Always take permission from the patient before examination
3. Insure privacy when taking information from patients
4. Avoid keeping patients for periods more than required by the
procedure.
5. It’s prohibited to examine the patient in the corridors or in the
waiting area.
6. During examination, no foreign person unrelated to the patient
allowed
7. Give patients enough time to expose the part with pain
8. Only relevant personnel are allowed to enter the examination
room

9. CONFIDENTIALITY

10. Why is there a Duty for Confidentiality?
• Trust between patients and health
professionals.
• Patients give information about their health in
confidence.
• Individuals will be encouraged to seek
appropriate treatment and share information
relevant to it.

11. Proficiency (Medical) Secret
• Medical secret is defined as “Any medical information that
comes to the knowledge of the practitioners as a result of
their work whether directly obtained from the patient, or
otherwise”
• It includes any information that the doctor (or treatment
team) knows about the patient (alive or dead), directly or
indirectly that a patient may deem its disclosure undesirable
or harmful to his/her health, reputation, financial, social or
professional status.
• It includes any information about the patient’s identity,
condition, diagnosis, investigations’ results, treatment, and/or
prognosis (whether chances of cure, disability, or death)
(Source: https://sites.google.com/site/ghaiathme/medicaleducation/practitioner-1/practitioner)

12. What is Confidential?
• All identifiable patient information, whether written,
computerised, visually or audio recorded or simply held in the
memory of health professionals, is subject to the duty of
confidentiality.
It covers:
– The individual’s past, present or future physical or mental health or
condition,
– Any clinical information about an individual’s diagnosis or treatment;
– A picture, photograph, video, audiotape or other images of the patient;
– Who the patient’s doctor is and what clinics patients attend and when;
– Anything else that may be used to identify patients directly or indirectly
– The past, present, or future payment for the provision of health care to
the individual,

13. Confidentiality Measures
1. Limit the accessibility to the medical records
2. Do not discuss the patient’s medical information with
unauthorized family members
3. Do not disclose patient’s information without his/her
consent, or in established exceptions (below)
4. Do NOT collect information not related to the provision
of care
5. Set policies that regulate access to medical information
and how any breach to confidentiality is managed
6. Limit sharing of information with other staff, unless in
cases of consultations and second opinion

14. Confidentiality Measures …cont.
All records
• Never inappropriately access records;
• Shut/lock doors, offices and filing cabinets;
• Query the status of visitors/strangers;
Manual records
• Hold in secure storage;
• Tracked if transferred, with a note of their current location
within the filing system;
• Returned to the filing system as soon as possible after use;
• Stored closed when not in use so that the contents are not
seen by others;
• Kept on site unless removal is essential.

15. Confidentiality Measures …cont.
Electronic records
• Always log out of any computer system or application when
work is finished;
• Do not leave a terminal unattended and logged in;
• Do not share Smartcards or passwords with others;
• Change passwords at regular intervals;
• Always clear the screen of a previous patient’s information
before seeing another.
Email and fax
• Whenever possible, clinical details should be separated from
demographic data;
• All data transmitted by email should be encrypted

16. Conditions to Disclose Medical Secret
1. Approval from the patients or their SDM, within the limit
given in the approval
2. If the information are required by judiciary {‫الشهداء‬ ‫يأب‬ ‫وال‬
‫دعوا‬ ‫ما‬ ‫إذا‬{ }‫قلبه‬ ‫آثم‬ ‫فإنه‬ ‫يكتمها‬ ‫ومن‬}
3. Consultation or second opinion
4. Notification of events of public health interest/threats
(birth, death, notifiable diseases, etc.)
5. Prevent individual/personal threats (e.g. prevent crimes)
6. If needed by the doctor to defend him/herself before
judges, or discipline committee
7. If the patient consciously and truly admits committing a
crime on which another person was accused/punished
Remember: Disclosure should be only to the concerned
party & not beyond the needed limits
‫أوضح‬‫في‬ ‫الضابط‬ ‫أن‬ ‫الشريعة‬ ‫فقهاء‬‫كشف‬ ‫أو‬ ‫ستر‬‫منع‬ ‫هو‬ ‫المريض‬ ‫سر‬ ‫عن‬ ‫الطبيب‬‫المفسدة‬ ‫ظهور‬

17. Fiqhi & Legal Aspects
•"َ‫ل‬‫و‬ُ‫س‬َّ‫الر‬ َ‫و‬ َ َّ‫اَّلل‬ ‫وا‬ُ‫ن‬‫و‬ُ‫خ‬َ‫ت‬ َ‫َل‬ ‫وا‬ُ‫ن‬َ‫م‬‫آ‬ َ‫ِين‬‫ذ‬َّ‫ال‬ ‫ا‬َ‫ه‬ُّ‫ي‬َ‫أ‬ ‫ا‬َ‫ي‬َ‫ت‬ ُْ‫ت‬‫ن‬َ‫أ‬ َ‫و‬ ُُِْ‫ت‬‫َا‬‫ن‬‫ا‬َ‫م‬َ‫أ‬ ‫وا‬ُ‫ن‬‫و‬ُ‫خ‬َ‫ت‬ َ‫و‬َ‫ون‬ُ‫م‬َ‫ل‬‫ع‬(27")
•‫قال‬ ،ْ‫وسل‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫بي‬َّ‫ن‬‫ال‬ ‫عن‬ ‫عنه‬ ‫هللا‬ ‫رضي‬ ‫جابر‬ ‫عن‬:((َّ‫د‬‫ح‬ ‫إذا‬‫الرجل‬ ‫ث‬
‫ة‬ ‫أمان‬ ‫فهي‬ ‫التفت‬ ْ‫ث‬ ‫بالحديث‬))‫اَللباني‬ ‫وحسنه‬ ‫والترمذي‬ ‫داود‬ ‫أبو‬ ‫رواه‬
• To consider the disclosure of medical secret a crime, there are 4
conditions: ‫الطبي‬ ‫السر‬ ‫افشاء‬ ‫جريمة‬ ‫أرُان‬
1. Medical secret ‫الطبي‬ ‫السر‬ , i.e. what was disclosed was a secret
2. The actual disclosure ‫اإلفشاء‬ ‫فعل‬ regardless the way of
disclosure
3. To be the person trusted to keep the secret ‫يكون‬ ‫أن‬‫المفشي‬ً‫ا‬‫أمين‬
‫السر‬ ‫على‬.
4. The intention to disclose (‫الجنائي‬ ‫القصد‬.) , e.g. not out of
negligence or forgetting, e.g. leaving the records open or
accidently dropping a medical information sheet

18. ETHICS OF MEDICAL RECORDS

19. Ethics of Documentation and
Authentication (Saudi Code of Ethics)
• They should document each procedure that he/she
follows with the patient in accurate records, and strive
to be accurate when writing medical reports, in a way
that achieves the interest of the patient.
• They should write what is the true reality without
exaggeration or underestimation and should not be
taken astray by the bonds of kinship, passion, fear or
desire of benefit to write a medical report that is
untrue.

20. In Saudi Code of Ethics, the medical record
should contain:
• Appropriate clinical findings,
• Decisions and procedures made,
• The information given to the patient,
• Prescriptions or medications, as well as
• All the patient’s investigations

21. (A) Medical Record
1. There should keep clear and precise paper and electronic
records for the patients.
2. The medical record should be kept in a safe place, and
should not be accessed or handled unless by those who are
professionally-related (to the patients) persons,
3. All the procedures related to professional confidentiality
apply to all its contents.
4. All the contents of the medical record are the property of
the institution in which the patient is receiving his/her
treatment, but
5. The patient can have access to the record and have a copy of
it upon his/her request.

22. (A) Medical Record
4. In the event of referring a patient to another doctor,
the healthcare practitioner should provide for the
referred healthcare practitioner all the information
needed about the patient’s condition precisely and
objectively.
5. When writing the data and information, scientific
and administrative standards should be followed
when writing, and have every document related to
the medical record signed and dated.

23. (B) Certificates and Reports
• Doctors enjoy the authority to sign a variety of
documents that lead to grave consequences if they are
abused, including:
– death certificates,
– medical reports,
– sick leaves,
– certificates of patients’ attendance and others.
• Therefore, doctors have to ensure the correctness of
the information before signing any document.
• Documents that are thought to be fake, false, or
misleading should not be signed, instead follow the
recognized scientific and administrative standards.

24. Have You Ever Witnessed...?
• A patient fully exposed in front of a dozen eyes and
pairs of hands (rounds)?
• A patient being photographed without consent?
• A Couple of doctors chatting about their patients
over lunch?
• A doctor, who is a relative of the patient “having a
look” in his relative's medical record?
• A student approaching patients with questionnaires
without consent or institutional approval?