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The foundation of an effective doctor-patient relationship is based on mutual respect and trust. One of the main tenets of this trust is maintenance of Medical Confidentiality. Unless the patient is certain that his medical and personal information is kept confidential he is unlikely to divulge all that is necessary for his medical management. The doctor is under both an ethical and legal obligation not to disclose, without the consent of his patient, information that the doctor has gained in his professional capacity. Even if the information is acquired through a third party the doctor has a duty not to disclose, as it risks damaging the trust and the doctor-patient relationship.

Inappropriate release of confidential medical information may lead the patient to suffer:
i. Grief and distress from the loss of privacy and gossip about his illness.
ii. Social stigmatisation and discrimination especially in psychiatric, venereal illness and infectious diseases.
iii. Occupational discrimination and unfair dismissal from employment.
iv. Family disapproval, even divorce proceedings by his spouse.
v. Blackmail.
vi. Homicide by using knowledge of the patientsí drug allergies and drug interactions.

Medical confidentiality is not medical secret and not absolute. Medical information can be released in the following situations:
i. If the patient consents.
ii. If in the patientís own interest that information should be disclosed for his medical management but is either impossible or medically undesirable to seek his consent.
iii. Legal requirements - like the Infectious Diseases (Amendment) Act 1992, the Termination of Pregnancy Act etc. - where the law requires the doctor to disclose the information.
iv. By special court order.
v. Overriding duty to society to disclose the information:
- Criminal with gunshot wound.
- Mentally ill with homicidal tendencies.
- Epileptic patient continues to drive.
vi. Under certain circumstances for the purpose of medical research and statutory audit - eg. Cancer Registry.

Even if the doctor is required to release medical information he should disclose only that which is relevant for that purpose. In case of doubt the medical practitioner should consult his medical defence. The medical practitioner should at all times be able to justify his action to release medical information when called to do so.

A medical doctor in maintaining confidentiality must do it entirely for the patientís interest and not those of the doctor. A doctor fearing questions on his clinical diagnosis and decision cannot use medical confidentiality as a cover to avoid releasing information where appropriate.

At the same time medical practitioners have been required by third party payers like employers and Managed Care Systems to release diagnosis and details of treatment under their care - what is the legal position? Has the patient really given consent? What is the definition of giving consent? What if a solicitor or police want to have access to your patientsí records? In the age of information technology and the likes of National Patient Master Index (NPMI) system and other forms of electronic storage and transmission, how can confidentiality be adequately maintained?

All these questions and more will be addressed at the SMA Ethics Convention on Sunday 28 November 1999. SMA members who would like to submit case studies and questions for the Panel Discussion in the Mini Course in Ethics may do so to the SMA Secretariat. The SMA Ethics Convention carries with it 3 CME points. As the practice of medicine is rapidly evolving all doctors have to equip themselves with knowledge and skills on health law and ethics.


DR T Thirumoorthy
Organising Chairman
SMA Ethics & Practice Convention 1999