Privacy of patients' information in hospital lifts: observational study
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7422.1024 (Published 30 October 2003) Cite this as: BMJ 2003;327:1024
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
Patient commentary
‘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
Competing interests: No competing interests