Sunday, November 11, 2018

Intro (oral)

medical ethics

TITLE SLIDE

SLIDE 1: This is group one’s presentation about doctor patient confidentiality

SLIDE 2: before we begin, this is an overview of all the content we will cover, this
includes what exactly the definition of doctor patient confidentiality is and the
correlating codes of medical ethics, the exceptions to these codes and how to deal
with gray areas in the codes as well. These include advantages and disadvantages
shown through various cases we’ve come across and finally we’ve included some
potential improvements that can be established in the future.

SLIDE 3: Confidentiality is a pinnacle aspect of a doctor patient relationship. It is the

ethical duty of a doctor not to disclose information regarding a patient without their
consent. According to the laws of most countries, violations of medical confidentiality
deems punishment by fine or prison. Patients must be able to expect that information
about their health is kept confidential unless there is a good enough reason for there
not to be. So this includes

SLIDE 4:

• Any clinical information about an individuals diagnosis or treatment

• A picture, photograph video audiotape or other image of the patient

• Who the patient’s doctor is and what clinic they attend

• Anything else that may lead to identifying the patient

SLIDE 5: Hippocratic oath

SLIDE 6:

- The law authorizes some breaches of confidentiality (which we’ll mention in a

second) and most people would say these breaches are appropriate. A few of these
examples include

• In the us and Australia you must report suspected child abuse

• In Switzerland and the UK the physician is allowed to breach confidentiality to

report child abuse

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- In general, the exceptions to the rules of confidentiality can be summarized by the 5
Cs

• 5 Cs for the exceptions to the duty of confidentiality:

- Consent: confidential information can be released if the patient provides consent

to do so (or parent or guardian or surrogate)

- Court order: can release information upon the receipt of an order by a court of
competent jurisdiction

- Continued treatment: can be released for the continued treatment of the patient

- Comply with the law: to comply with mandatory reporting statutes (child abuse)

- Communicate a threat

SLIDE 7:

- so why is confidentiality so integral in a patient’s treatment?

- Well the right to any individuals privacy (patient or not) is personal and
fundamental, therefore medical information obtained and maintained by
physicians is privileged information. This means the patient should have right of
access to their files.

- The privacy regarding adolescents should also be respected. This means that if a
adolescent minor doesn’t want to tell their parent some piece of medical
information then they have the right to do so.

- Patients must consent to release of any of their information and the information
released should be kept to a minimum.

- It can also be disclosed in the case of law as mentioned before

SLIDE 8:

- how does a clinician deal with issues of confidentiality?

- We use the pneumonic DEAL

- D stands for duty to maintain the confidentiality in the context of a treatment

relationship

- E stands for exception, you must ask yourself as a physician does an exception exist
and then we think back to the 5 Cs

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- A is for ask, ask your colleagues for advice

- L is for law, which you should be familiar with.

SLIDE 9:

- So we use the code of medical ethics in medical practices: beneficence,

nonmaleficence, autonomy and justice. This means we act for the patient’s
wellbeing, we don’t do any harm, we respect our patient’s values and choices and
we treat each patient fairly

- The advantage of this is that it ensures patient’s trust and therefore we cant treat
them better

SLIDE 10:

- we in society have two competing interests. To maintain confidentiality in patient

care but also to solve crime. Usually in the case of law, the integrity of one of these
aspects like confidentiality must be forsaken to maintain the other, in this case its to
solve crime.

SLIDE 11:

- so in regard to this disadvantage, we have a case where a patient with homicidal

tendencies was being treated by a psychiatrist. The patient ended up killing a family
and the court charged the treating psychiatrist with liability. The psychiatrist ended
up not bein charged because mental health professionals only owe a duty to third
parties when the patient has communicated an actual threat of physical violence
against an identifiable victim.

- The psychiatrist never reported the patient before the incident because an aspect of
mental health treatment is the fact that the patient must feel trust in the doctor. If
there is no trust it interferes with the therapeutic relationship.

- The difficulty in treating patients with serious. health problems is that they are not
under the control of the physician. If a patient’s confidentiality had to be breached in
the name of the law, their therapy might be at risk.

- So we’re at a stalemate, do we want our patients to get better or do we have to put

our first priority in the name of the law

SLIDE 12:

- we have another case where a nurse learned about a patient’s STD and sent texts
about it to the patient’s girlfriend. The girlfriend was the nurse’s sister in law.

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- The patient called and sued the clinic even though the nurse was fired before he
sued

- Does this mean they cant be sued because the nurse was already fired? Well no. The
employer is liable for the nurse’s actions because they shouldve foreseen it and also
because she was acting within the scope of her employment.

SLIDE 13:

- this last one involves a study that depicts all the gray areas in medical confidentiality.
This includes a lot of day to day circumstances that happen in which breaches of
confidentiality may ensue.

SLIDE 14:

- this study conducted a series of 7 clinical vignettes that show different violations and
you had to answer on a scale of 0-3 as to if a violation occurred and if so how
severe.

- There were 378 pcps and 130 general practitioners, internists, physicians and
students from Italy Denmark Germany uk and Switzerland. Their ages were around
51 for community physicians and 36 for hospital physicians.

- The seven case scenarios are written here:

- 1. Treating a male politician and telling his (the physicians) wife about him later

- 2. A patient leaves their current gyne and goes to a new one. The current one calls
the new one and tells them she as active hep c.

SLIDE 15:

- 3. A patient’s purse is stolen from their coat from the waiting room of their GP. The
police requests all the names of the patients that was seen that day

- 4. A surgeon tells a forensic pathologist about the medical record of a patietn that
disappeared in order to compare it. to the autopsy report of a cadaver they found.

- 5. A woman that was beaten by the police was treated by a physican and that
physican later at a dinner party talks about her and mentions the places she was
found. Among the people he was telling was a lawyer.

- 6. A computer guy that’s repairing the computer of a dermatologist prints out a list
with the names of all the people that have been seen along with their bills paid and
unpaid.

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SLIDE 16:

So they were analyzed based on if they recognized a breach of confidentiality and if

they knew the severity of it

SLIDE 17:

Only 11% of all physicians recognized all six cases and their violations. The results
among physicians were similar to medical students.

SLIDE 18,19: just read off the slide