Public Disclosure of Health Records - Article Example

Public Disclosure of Health Records Public disclosure of health records is an issue that has always challenged our health care system and our legislators. The delicate balance of protecting the greater interest of the public versus protecting the patient from the public’s prying eyes has tipped back and forth in favour of either side of the issue. No side has ever firmly and decidedly won the argument. This paper presents the argument that the public’s interest should be taken more into account when the decision is made to disclose a person’s health details. It shall weigh in on the side of the greater good of the greater number of people. The Human Rights Acts validates the responsibility of medical personnel to avoid disclosure of confidential medical information. However, Article 8 provides exceptions to confidentiality rights when public interest is involved (Garside & Branthwaite, 2006). The Access to Medical Records Act of 1988 also gives the right to patients to review medical information contained in their records which may be submitted to their potential employers. Along with other relevant health-related legislation, these provisions take note of the public’s interest in considering possible breach of confidentiality agreements. In child abuse cases, public disclosure of health records is important. Many family members prefer to keep information about the child’s health and condition within the family. “The most difficult dilemma of all often arises in cases of possible child abuse or other criminal activity where individuals refuse to allow disclosure of information, despite the fact that silence puts other people at risk of harm” (Wilks, 1999). The potential for violence that might befall the child is often not prevented when social workers and other health care givers, who are privy to vital health information, have their hands tied by the confidentiality agreement. Public interest is important where “disclosure to the relevant authorities of suspected abuse or neglect of a patient who does not have the capacity to consent, such as a young child or someone with mental disability is considered to be in the patient’s best interest” (Tranberg & Rashbass, 2004). In cases where the patient has the capacity to consent, his wishes must be respected, except where the abuser may also potentially harm the minor children of the patient. For the greater interest of the minor children and other people who may also be harmed, medical records should be disclosed to authorities. “The rights of family members to privacy can also come into conflict with the public interest when health records indicate suspicions of non-accidental injury to a vulnerable child or adult” (Wilks, 1999). In the interest of justice, parents and caregivers may also be allowed to view the medical records of their children in order to give them a chance to explain the child’s injuries (Lyon, et.al, 2003). Children have a naturally playful nature and their injuries may be a result of their playfulness, and not because of any physical abuse. In the case of medical and other health practitioners who suffer from medical conditions that may put patients at risk, public interest must also supersede the rules and regulations on confidentiality (Tranberg and Rashbass, 2004). The nature of the medical practitioner’s contact with the patient is such that possible accidents, like pierced gloves and needles puncturing practitioners would place patients at risk of being contaminated by the practitioner’s illness. And in order to protect the patient from possible contamination, public interest demands disclosure of practitioner’s health records. Many general practitioners also hold vital information about patient’s family history that would help in determining the health history and possible health problems that might surface in the family. This information sometimes does not belong to the individual, but to the family. The problem of confidentiality is seen when family members prefer to keep vital health information about deceased family members. “Patients recollection of family illnesses can sometimes be inaccurate or lack detail” (Lucassen, et.al, 2004). Therefore information which is obtained from medical records of patient is very important and much more accurate. Medical health records are also being requested by third parties for a variety of reasons. Health records are needed in order to avail of state benefits, in seeking employment, and in applying for insurance. Various insurers often ask to see medical records of potential clients in order to decide amount and risk of coverage. Before coverage or benefits is also sought from the state, the state naturally reviews the patient’s medical records. This is a practical move in the interest of putting valuable state funds into the care of patients. It is important for the state to know that they are putting the precious taxpayer’s money into good use. Potential employers have now made it a part of the employment process to request patient’s medical records in order to assess the condition of their employees. By knowing the employee’s condition, accidents in the workplace may be prevented and job productivity may be increased. The employer would be enlightened about his employees, how healthy they are, and the health problems they have. The employer would also know the jobs that would not fit certain employees because of health problems. Prevention of disclosure of medical data in cases of the younger population also makes it difficult for parents and social workers to protect and help the patient. The confidentiality agreement in its purest form prevents the revelation of medical information to parents and other concerned authorities. However, to let this rule stand in the face of danger to the patient’s life is just wrong. Many young people suffer from emotional problems that lead them to harmful and dangerous behaviour. Letting the parents and social workers know about their vulnerable mental state can assist family members and health care givers in coming up with suitable medical interventions for the patient. There is also now an increasing demand on health professionals to reveal information to third parties like the police, social workers and driver licensing authorities. These are parties who have a vested interest in vital health information and in helping keep the patient and the public safe. There are various individuals who have medical conditions that make them dangerous drivers. These individuals sometimes ignore medical advice and insist on obtaining licenses. By allowing the DVLA to look into the medical records of the applicants, it is possible to rule out any medical conditions that would make the applicant a dangerous driver. Giving the DVLA access to the medical records will help keep the public safe from drivers who are medically unfit to drive. In the interest of the general public, health records and information should be disclosed. This is especially important for people who should know and have a right to know about a worker’s medical history-- like medical health personnel who may administer first aid in the work place. During their clinical practice, these medical personnel might come in close contact with workers who have transmissible diseases. As a result, they may unconsciously acquire the disease themselves or transmit the disease to other patients in their care. The medical personnel should know when to take extra care in administering medical interventions on the patient and to prevent contaminating himself and/or others (International Labour Office, 1993). In the case of Mr. X v. Hospital Z, the issue was put forth on whether the duty of confidentiality overrides the public interest in informing the spouse of an HIV positive patient. The Supreme Court of Canada ruled in this case that the doctor-patient confidentiality rule was not applicable in instances where the patient had a great potential risk of infecting his or her spouse. In these instances, the right of confidentiality is not absolute and must be restricted. The UK General Medical Council Guidelines allows for the revelation of confidential information in cases where public interest is concerned. There are steps that are taken before medical records may be disclosed to the public or to other parties. This includes persuading the “HIV/AIDS patients to tell those at risk of his or her status, or otherwise give consent for the medical practitioner to do it on his or her behalf” (Mae, 2006). The UK National Health Services Regulations 1974 specifically notes that in cases of sexually transmissible disease sufferers that have treatable conditions, their identities should still be kept secret. Only those who are considered high risk need to have their records disclosed to their family members, spouses, and friends. At this point the burden of the risk is transferred to the family members and friends. They would no longer be blind sighted in case they would find themselves infected with the disease. The public interest is also important in instances where an HIV/AIDS positive patient is living a sexually active and promiscuous life without taking any precautions to prevent infecting his or her partner. “…[I]ndividuals engaging in unsafe practices may underreport their behavior in an effort to avoid the personal sense of guilt and social disapproval they fear such a disclosure would evoke (Siegel, et.al., 1994). In these cases, public interest is the primary motivation for disclosing medical records. Because of the possibility of transmission of the disease through sexual contact and needle sharing, the disclosure of health records is vital in containing the disease. Many doctors practicing in the army feel that the sexuality of the soldiers should be made public. This will help ensure that those in the service would be regularly checked and screened for AIDS. Their potential for acquiring AIDS is higher than their heterosexual counterparts. This will help carefully monitor their health status and the health of other soldiers. The interest of the public is also vital in instances where there is a need to identify possible carriers of diseases. In order to contain highly transmissible diseases, designated authorities must be given a chance to look into the medical records of suspected carrier patients. This will help the medical personnel determine their succeeding interventions in caring for the patient and what precautions they decide to undertake to prevent the spread of the disease. This will also help identify other possible individuals who have had contact with the patient and to determine areas of possible quarantine and containment. The public interest is also of utmost concern in instances where a possible offense of crime would be committed and there is no other way of obtaining crucial information except through medical records. By allowing a confidentiality breach in the interest of the public, it is possible to identify the possible perpetrator of a crime and to protect the possible victim. This is especially applicable to mentally ill patients who reveal to their psychiatrists their intent to kill or harm another person. Their medical records may also reveal their homicidal tendencies which would be in the best interest of the public to know. This vital information will help the authorities decide on how to deal with the patient and what possible precautions they can undertake to prevent harm from coming to other people and even to the patient himself (Tranberg & Rashbass, 2004). The interest of the public plays a large and vital part in the breach of the confidentiality agreement. The confidentiality of medical records gives the patient a trusting relationship with his caregiver. However, this agreement is not absolute. And nothing less than the interest of the public allows for a breach in this agreement. The public’s interest takes precedence to individual interests in instances where a patient’s medical information, if unrevealed to concerned authorities, would bring more harm than good to the public and ultimately the patient himself. “The law recognizes an important public interest in maintaining professional duties of confidence but the law treats such duties not as an absolute but as liable to be overridden where there is liable to be a stronger public interest in disclosure” (Forrester & Griffiths, 2005). Even if a breach of information is allowed and encouraged in favour of public interest, the law has enough safeguards, precautions, and regulations to ensure that the breach of confidentiality is not abused. It should be made clear that disclosure applies to limited circumstances only and only to relevant authorities. Works Cited Garside, J. & Branthwaite, M. (2006). Law for Doctors: Principles and Practicalities. London: RSM Press International Labour Office (1993). Workers Privacy: Testing in the Workplace Pt. 3. London: International Labour Organization Lucassen, A., et.al. (17 April 2004). Education and Debate. British Medical Journal: 328:952- 953  Lyon, C., et.al. (2003). Child Abuse. New York: Jordans Mae, P. (2006). Medical Confidentiality and the Public Disclosure of HIV status. PACLII.Org. Retrieved 05 November 2008 from http://www.paclii.org/journals/fJSPL/vol08no1/4.shtml   Siegel, K.,et.al (1994). Reporting recent sexual practices: gay mens disclosure of HIV risk by questionnaire and interview. Questia.Com. Retrieved 05 November 2008 from http://www.questia.com/googleScholar.qst;jsessionid=JRXLvd1nnmJ8m9Qg2f7szBh2z7wmVkD9WDJ6vqTx78k3HdnnGr5x!2142771688?docId=5000209290 Tranberg, H. & Rashbass, J. (2004). Medical Records Use and Abuse: Use and Abuse. Oxford: Radcliffe Publishing Forrester, K. & Griffiths, D. (2005). Essentials of Law for Health Professionals Australia: Elsevier Wilks, M. (14 October 1999). Confidentiality and Disclosure of Health Information. British Medical Association. Retrieved 05 November 2008 from http://www.bma.org.uk/ap.nsf/content/Confidentialitydisclosure Read More