Series of lectures I gave for the PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS). 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

1. Asst. Prof., Dept. of Medical Ethics
King Fahad Medical City – Faculty of Medicine
King Saud Bin Abdul-Aziz University for Health Sciences
Dr. Ghaiath M. A. Hussein
Professionalism and Ethics Education for Residents (PEER)
Privacy, Confidentiality and
Medical Records

2. 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

3. Privacy and Confidenciality?
EXERCISE….

4. 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

5. PRIVACY

6. 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

7. 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

8. CONFIDENTIALITY

9. 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.

10. 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,

11. 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

12. Confidentiality Measures …cont.
All records
• Never inappropriately access records;
• Shut/lock doors, offices and filing cabinets;
• Query the status of visitors/strangers;
• Advise senior personnel if anything suspicious or worrying is noted;
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.

13. 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 to prevent others using them;
• 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;

14. Proficiency (Medical) Secret
• 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)

15. Conditions to Disclose Medical Secret
1. Approval from the patient or his/her SDM, within the limit
given in the approval
2. If the information are required by judiciary
3. Consultation or second opinion
4. Notification of events of public health interest/threats
(birth, death, notifiable diseases, etc.)
5. Prevent individual/personal threats (crimes, STIs, ?)
6. If needed by the doctor to defend him/herself before
judges, or discipline committee
7. ? “for the doctor to disclose some or all of the secret if
she/he deems this necessary to the cure of the patient!”

16. 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?

17. Questions & Discussions
• More information on the Medical ethics
Course:
https://sites.google.com/site/medicalethicscourse/