I have become aware recently of how much personal information is tossed about indiscriminately, and how we seem to worry about this less than we should.
I have become aware recently of how much personal information is tossed about indiscriminately, and how we seem to worry about this less than we should. The advent of social networking, with the technology to allow it, has meant that little personal information stays private for very long.
Confidentiality is at the heart of the doctor-patient relationship. Without it, we would have a hard time taking a proper history, and without it we could not be seen as reliable and trustworthy professionals. Our patients trust us to keep their personal information secret, even though the boundaries of such trust may be stretched when we discuss cases with colleagues or at rounds. And yet anyone walking the corridors of any reasonably sized hospital will pick up snippets of information that they really should not hear.
Sometimes it’s much more than that. Imagine that your elderly mother has been taken to the ER because of acute abdominal pain and vomiting. Now, imagine that you find her being interviewed at high volume (she is hard of hearing) and examined behind poorly drawn curtains in a busy unit. Her distress during the examination is heard (and partly seen) by all in the vicinity. Because she is by nature an undemonstrative person, her discomfort is extreme. It’s a distressing scenario, and we cannot assume that she is prepared to surrender her dignity in order to receive care. Her distress—and yours—would be greatly reduced by the provision of privacy during her assessment. It’s not much to ask.
But it’s not just in clinical and hospital settings that privacy doesn’t seem to be as important as it should be. The CMA’s Code of Ethics requires physicians to disclose a patient’s information to a third party only with the patient’s consent or as required by law (which relates to the public good). Pharmaceutical companies, in seeking to improve market share, have taken to using market research companies to probe how clinicians think when they formulate management plans. The market research companies dangle cash in front of clinicians to obtain “patient profiles,” assuring respondents that such information will be kept confidential and will be used only to improve patient care (no mention of industry profits or market share).
When I responded to one of these requests by saying that I did not have consent from my patients to share their information with a market research company, I was assured again that the information “would be kept confidential.” But, I said, if I’ve passed a patient’s information on to you, then it is no longer being held in confidence by me—right? The market research company’s response was tangential, assuring me that they adhered to the International Code on Market and Social Research. Good for you, I responded, but the fact will remain that I have breached a patient’s confidence by passing on his or her details to you, and will have profited by doing so—with no benefit for the patient. I hoped for a further response, but didn’t get one, and can only assume that my e-mail address has been removed from another list (or transferred to a black one).
From Hippocrates onward, we have all been made aware of the need to respect every patient’s right to privacy. Expediency and legal issues mean that this right is sometimes stretched and very occasionally (because of legal considerations) waived. But in every case we should think twice before disclosing any patient information to others, and if in doubt seek consent from the patient to do so. We all have information about ourselves that we surrender with reluctance. Who we surrender it to should be up to us.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org