Difference between Confidentiality and Privilege
So first off you're probably wondering what the difference between doctor patient confidentiality and doctor patient privilege is or if they actually mean the same thing? Doctor patient confidentiality is more of a moral obligation that doctors have to their patients, to not disclose any of the patient's records or details provided to the doctor during a medical check-up.
On the other hand, doctor patient privilege or physician patient privilege as it's now called, is a legal concept1 that protects the communications between a patient and his or her doctor, which means that a doctor cannot testify against his or her patient (without the patient's consent), in court by disclosing any kind of information regarding the patient that the doctor may have acquired during his interaction with the patient.
How Important is it?
So the next question is what is the importance and relevance of the doctor patient privilege? The answer is simple. The first and foremost priority of a doctor is to ensure the correct diagnosis of his or her patient and the only way to make a correct diagnosis is by understanding all the symptoms and potential cause of symptoms. Doctors can acquire this information from their patients if and only if patients feel safe and believe that the information disclosed to their doctors will not be disclosed to any third party, especially if this information incriminates them or threatens them. So in short, the doctor patient privilege was introduced to ensure that patients feel safe and trust their doctors enough to be honest with them so that doctors can make the right diagnosis and efficiently treat the patient.
For example individuals going for therapy would be a lot more forthcoming to their therapist if they know that their medical records won't be subject to scrutiny by their family members or by the media (if the patient happens to be a celebrity). Also, individuals who are victims of crime and abuse would probably not go for treatment at all if they knew that their doctors after treating them will go to the police to report the abuse (thereby potentially threatening the victim's life).
The real reason, however why doctor patient confidentiality is even a source of discussion is due to the ethical dilemma that it poses. For example, in situations where a patient is a victim of gunshot wounds and does not wish to be identified as the victim of a crime – is the doctor's first prerogative to protect the right to privacy of his patient or should his first concern be reporting the crime to the police so that the criminal can be identified and further injuries and loss of life can be prevented? So fundamentally the question is whether it's ok to sacrifice the rights of an individual for the greater good? On the flipside of this argument one would be justified in saying that if doctor patient privilege is not maintained then victims, like the ones mentioned above may not come forward for treatment at all, in fear of being incriminated.
There is no right or wrong answer to this dilemma as it completely depends on which perspective you're looking at it from, but courts that accept doctor patient privilege maintain that this privilege is not absolute and that in matters of public welfare like reporting of child abuse and gunshot wounds, doctors have a larger duty to the general public.
If you research enough on this topic you'll find that the major concern for proponents of this privilege is the protection of medical records. Most of them are concerned with the digitalized form in which this data is and how difficult it actually is to protect this information. To me at first it seemed ridiculous – A – why would people want to look into your records and B – what's the big deal if they did? Maybe that's because I'm Indian and in India we have much bigger fish to fry than the doctor patient privilege and protection of medical data. In the global context however, I realized it was of prime importance as in the western hemisphere of the globe citizens take the breach of their civil liberties more seriously than we do. Here is an example of what I mean.
Example
Velazquez v. St. Clare's Hospital, (Kings County Supreme Court, New York, 1994)2. Nydia Velazquez was admitted to St. Clare's Hospital in 1991 after attempting suicide. In 1992, while she was running for election to U.S. House of Representatives, copies of her medical records were faxed anonymously to several newspapers, which ran them in front-page stories. It was never determined whether hospital personnel were responsible for the disclosure. Regardless, Velazquez sued the hospital for breach of contractual and fiduciary duties of confidentiality, for wrongful disclosure, and for negligence in maintenance of the security of her medical records. Needless to say she won the lawsuit.
Research in the Journal of the American Medical Association found examples of web gossip by trainee doctors sharing private patient stories and details. Over half of 78 US medical schools studied had reported cases of students posting unprofessional content online through social networking sites like Facebook and Twitter. Many postings included profanity and discriminatory language. Many blog postings contained sexually suggestive material and photos showing drunkenness or illicit drug use. In this context it's pretty clear why patients would want their data to remain confidential.
Conclusion
I'd like to conclude this article by giving you a perspective on how serious the doctor patient privilege is considered in western nations like UK as opposed to its importance in India. In UK the BMA (British Medical Association) opposed certain clauses drafted by the NHS (National Health Service- the shared name of three of the four publicly funded healthcare systems in the United Kingdom) claiming that the bill gives very broad powers to a number of bodies, including the Secretary of State, the Commissioning Board and the NHS Information Centre "to obtain and disclose confidential patient information for any number of unspecified health purposes."3 In India however the only tangible or recognized law that glances at doctor patient privilege is the Indian Contract Law that states that patient confidentiality must be maintained. However, this can be overridden in certain cases if it's in the interest of the larger public. What this implies is that there's a gray area – where the decision to disclose information or not lies at the discretion of the doctor. My point here is simply that beyond the Indian Contract Law (which leaves room for a lot of interpretation) there is nothing more substantial in lieu of protection of patient information. This is probably because not many people here would sue a hospital or doctor for disclosure of medical data. However the lack of awareness of civil rights among citizens cannot be an excuse used by medical authorities to not formulate better policies for protection of confidential information of patients.
Information Source:
1- http://www.enotes.com/topic/Physician%E2%80%93patient_privilege (The ambit of this privilege varies from country to country)
2 - http://www.enotes.com/nursing-encyclopedia/patient-confidentiality
3 - http://www.bbc.co.uk/news/health-12557777
Image source: http://www.flickr.com/photos/51937229@N05/5815015625/
The author V.Priyadharshini is a freelance writer at GyanCenrtal. She is currently pursuing BBA from NMIMS University
