The Dilemmas for Practice and Privacy

1. Modupe Sarratt
IFMS 300 Activity 2
Medical Privacy Act for Confidentiality in the Information Technology is a Misleading
Notion, Impossible, and Unethical.
The four common approaches to ethical decision making are privacy, reliability,
integrity, and security.
Medical privacy rule for confidentiality mandated by HIPAA that information
shared by the patient or the client with the doctor or the therapist in the course of
treatment are not shared with others or are limited to people that have the right or the
need to know in a legal system with freedom of information and the public right to know.
There are no way a doctor or a therapist to keep a patient or a client medical
record confidential without being unethical, or breaking the Hippocratic Oath “to do no
harm” to none. By the law is not legal to burn or shred medical record.
First, the process or the procedures for patient and doctor relationship is by
transformation of information with technology, for example patient appointment ,
medical insurance, the reason for the visit, and patient personal history such as
demographic were obtained by phone call or by email that have to be document into the
computer, and if walk in is allowable, patient information and that time that the patient
walk to the doctor office and the reason for encounter have to be documented into the
computer and verify. In additional, hard copy information has to be input into the
computer. Besides, it is impossible for medical field and medical privacy act to function
without information technology.
The temporary notion for confidentiality is a fallacy in the doctor and the patient
relationship because what the patients and the clients want to keep confidential are
communicable illness and odd occurrence that the doctors or the therapists were
obligated by the law to report to the public health, and public health are obligated to
inform and warn the public.
Therefore, where and when do confidentiality of information that requires ethical
standard or principle in the medical privacy act?
These two imagined examples explained why confidentiality of medical record is
false and unethical. These two examples might seem feigned, but are predictable.
The first example, a wife requested that her diagnosed for HIV should be kept
confidential from her husband while receiving treatment. A year later, the husband was
diagnosed with full blown aid.

2. In the course of the husband disbelieving and questioning for how he contracted
the disease and that it is not possible for him to have aid when his wife is healthy and
he never cheated on his wife, or being associated with the notion of having exposure to
HIV infected person and his knowledge that his wife never being expose or diagnose
with HIV either. Him and his wife are healthy and in monogamy relationship. This
example made it impossible to keep the wife medical record confidential despite the
medical privacy act and without breaking the doctor and patient relationship for
confidentiality. In addiction, is the legal impact for the doctor Hippocratic Oath “do no
harm” to none. Harm for deception was done to the husband because the husband
never has the opportunity to receive treatment before is too late.
What is more, for unethical was how the wife contracted the disease was
documented in the wife medical record for having an affair with known aid patient that
was not known by the wife during the time of the affair. However, the scenario play out,
the medical privacy for confidentiality was unethical and harmful to others. Besides, the
confidentiality cannot remain confidential, therefore, is not private, not reliable, lack
integrity, lack assurance for security, and is false.
The second example, a judge visit a doctor office as a patient for physical
checkup due to experiencing pain during intercourse and physical sign of swelling in the
genital area that the patient assumed to be warts, off and on flu like symptoms with
fever, sore throat, and night sweat and lethargy for about three months, that is getting
worse. In addition to the physical signs was patient concern for having unprotected
sexual encounter with known HIV positive that now have TB. The doctor referred the
patient for blood test and chest x ray.
Input of the judge information into the lab computer for blood test came with the
information that the patient was a district judge for the juvenile court that was name as
sexual encounter by a patient that is now diagnosed with full blown AID, also indicated
the judge having sexual encounter with a minor under investigation.
The lab tech expression during the intake arouses the judge curiosity for
information. In the process of lab work for blood test, the judge found out about public
information of him that was unknown to him because as a patient the judge has the right
to his medical record. How this example play out was riotous, it includes, government
concern, economic concern as to the judge position, and medical privacy, how private
and secure with the people who have the need to know, such as the lab tech. The
second example is a debate for medical privacy act for those who have the need to
know.

3. The conclusion for the imagined examples scenarios and for medical privacy act
for confidentiality are misleading notion, false, and unethical infer with this article by
Richard C. W. Hall, M.D, “Ethical and Legal Implications of Managed Care”. (Hall)
The abstract of the article, Dr. Hall “addresses several ethical, regulatory and
legal issues in managed care with attention to recent court cases that focus on
physicians' responsibility, fiduciary duty and the impact that these legal decisions have
on physicians practicing in a managed care environment”.(Hall)
The article continues with Dr. Hall “raised questions as to whether critics of the
system argue that managed care is reducing the introduction of new technology,
interfering with the physician-patient relationship, worsening outcomes, restricting
clinical research, reducing funding for physician training and adversely effecting
community based hospitals. Others raise concern about monopolistic trade practices,
ruthless business techniques and the subversion of medical ethics”. (Hall, para 2)
In addition, the article references manage care interpretation for “The Hippocratic
Oath emphasizes the primacy of trust in the relationship between patient and physician.
It obligates the physician to keep his/her patient's information confidential, to avoid
mischief and sexual misconduct, and to give no harmful or lethal agents. Over time,
patients have come to expect that their physicians might even jeopardize their own
health to care for the ill.(33) In short, the physician becomes the advocate for his/her
patient, using his knowledge and the patient's trust for the patient's good”. (Hall, para
10)

4. Reference
Hall, Richard C. W RCW: Ethical and Legal Implications of Managed Care.
CourtesyClinical Professor of Psychiatry University of Florida, Gainesville
http://www.drrichardhall.com/ethical.htm