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Rapid Responses: Rapid Responses published:
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Breach of patients’ confidentiality and Data Protection Act 1998 can be legally prosecuted
- Humayon Pervez (1 November 2003)
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Lifts are not the only place of breach of confidentiallity
- Sebastian Hendricks (3 November 2003)
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Not only lifts
- Graham R Howarth (3 November 2003)
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Better use the stairs?
- Timothy D Heymann (24 November 2003)
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Patient commentary
- Heather Goodare (31 March 2004)
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Humayon Pervez, SpR (LAS) Trauma and Orthopaedics Luton and Dunstable Hospital NHS Trust
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Respect for the confidentiality of patients' information is a basic principle of ethical and effective medical practice. It has also been noted that paper containing patients’ identifiable information and some times laboratory results are discarded in waste paper bins and waste taken to the public land fill tip. Breach of patients’ confidentiality and Data Protection Act 1998 can be legally prosecuted. It is therefore of paramount importance that patients’ identifiable information must be disposed of in correct manner by using shred safe bags. Separate lifts for hospital health care staff and public can prevent patients' information being overheard Dr Saadia Humayon Mr H Pervez Competing interests: None declared |
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Sebastian Hendricks, Specialist Registrar Audiological Medicine Royal National Throat, Nose & Ear Hospital, London WC1X 7DA
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As daily commuter on Britain’s Rail into London for years one comes across breaches of confidentiality nearly on a daily basis. The positive is it widens your knowledge not only on financial or law issues, but also the medical one. This type of education has surely not been approved by any college nor by the patients concerned or the GMC. The breach of confidentiality occurs in multiple ways. Firstly, doctors can be overheard talking on the phone about a patient to a colleague or even giving a handover. The speciality and their grade soon become clear, they drop first or last names of patients and don’t seem to be aware of their surrounding. Secondly, reports about patients or hospital issues that might be better off left with the hospital setting can be observed being read. Thirdly, colleagues discuss general work issues in public transport but intermittently drop patients’ names and other confidential information. I can observe a breach of patients’ or trusts’ confidentiality on several occasions for each of these areas every month. Therefore, I am very pleased to read Mr Vigod’s et al. publication to draw attention to this ethical health care problem and to suggest better training. But, how do we implement the training and evenly important how do we maintain the learned change in behaviour? Relating to my examples above I used two different methods. 1) I attempted to look very interested in the conversations, or tried very obviously to read in their files with them, etc. As a consequence people either realised, gave me angry looks and changed topics or closed their files, or continued their conversation or reading without even noticing me. 2) In some of the cases where people did not realise my attention, I attempted to address the problem carefully. A typical reaction was anger and a comment that I should mind my own business. Some apologised to me (I don’t know why to me) and stopped discontinued. I appreciate that doctors with long commuting journeys try to use the time for work purpose and it might be appropriate in other areas than medicine. My severe concern is that some, particularly senior colleagues, might have a misperception of patient confidentiality, which might be difficult to address. As I do not think that my approach is a very appropriate way to deal with the individual case I hope that training can also address the problem addressing the issue with a colleague when it occurs. Competing interests: Employed by the same instituition as possibly most of those people as I report on. |
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Graham R Howarth, Medico-legal advisor MPS, Granary Wharf House, Leeds, LS 11 5 PY
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Inadvertent breaches of confidentiality are not limited to lifts. Our advisers are surprised at how often breaches occur on mainline trains. These breaches occur during conversations between doctors, during mobile telephone calls and during dictation. Interestingly the oversight is not limited to the medical profession, the other major offenders being lawyers. If such discussions are necessary on a train, then hushed tones should be used and confidentiality maintained by use of stringent anominity. Competing interests: Medico-Legal Advisor for Medical Protection Society |
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Timothy D Heymann, Consultant Physician and Gastroenterologist Kingston Hospital, SURREY KT2 7QB
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Perhaps we should encourage more of our colleagues who are physically able to use the stairs? Vigod et al's paper suggests that few do so, a view my own observations in hospitals support. Colleagues' own health may benefit. Their patients' confidentiality may be better safeguarded too. Competing interests: None declared |
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Heather Goodare, Cancer counsellor Horsham
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‘Walls have ears’, and ‘Careless talk costs lives’ are slogans I remember from my wartime childhood. They seem relevant here. Are Canadian, American and Danish hospital staff more indiscreet in hospital lifts than British? I asked myself. Perhaps the British are more tight-lipped: I have not heard indiscretions in lifts, but occasionally in corridors. A study of gossip in hospital corridors would no doubt present considerable logistical problems. However, a much more serious issue in the UK is the general laxity about confidential matters inevitably caused in many cases by poor facilities and surroundings. In my experience, patients complain about private consultations being overheard on the ward by other patients: drawing the curtains round a bed does nothing to screen off sound, and it is disconcerting to have one’s intimate physical details broadcast to all within earshot. Those receiving bad news – say, the diagnosis of a life-threatening disease – need privacy, and should always be offered a private consultation in a specially designated office. It is also unethical for social workers to discuss family matters with patients within the hearing of others: but this too happens – again, perhaps there are no proper facilities available. ‘Clare’ in Cancer Tales relates how a sympathetic doctor has to tell her all the details of how her pelvic radiotherapy will affect her (‘we need to make sure that your vagina stays open’) in a claustrophobic waiting-room full of other patients (‘I am in this small space and all these people are near and could hear everything the women looked interested and the men hid their faces in their hands I know the young doctor is doing his best in an impossibly undignified situation I long for privacy I long for dignity’). (1) Just as alarming is the report on the use of information technology in general practice where among a sample of 77 practices, none paid the necessary attention to data security, which was ‘the single most concerning aspect’ of the study. (2) The authors make several recommendations for preventing unauthorized access to confidential data. So what should be done? First, a compulsory module in all medical and nursing training in communication skills and medical ethics; second, better training for all those in any way involved in processing computer data; third, far better facilities in hospitals for confidential consultations, so that the skills learned by young doctors and nurses can be practised appropriately, with compassion and respect for the patient. However, one must ask how effective training can be, when one’s seniors seem to affect different attitudes. In the above study it was medical students only who attempted to ‘minimize breaches of patient confidentiality’ when they occurred in hospital elevators. Does this indicate that on graduation doctors become cynical, hardened, and insensitive? Or that many senior staff graduated before such training became available? Another explanation may be that healthcare professionals do not have enough appropriate opportunities for debriefing in a supportive environment, and find themselves letting comments about patients (and even colleagues) slip out unawares in public places. One may sympathize with their problems, but still feel that professionals should behave professionally. Training in itself is not enough: ongoing support is also important. Is it asking for the moon in the cash-strapped NHS to require all patient interviews of any significance to be conducted in private? To be practical, each ward or department should have a private room where such interviews can take place. It should not be impossible to provide appropriate facilities even for the bed-bound, whose beds could be wheeled into a private area. Patients deserve no less. 1 Dunn N. Cancer Tales. Charlbury: Amber Lane Press, 2002: 52. 2 Smith J J, Smith R J, Beattie V, Beattie D K. Use of information technology in general practice. J R Soc Med 2003; 96: 395-397. Competing interests: None declared |
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