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Royal hospital scandal shows patient privacy is a matter of ethics

Can we please stop describing the efforts of two Australian DJs to get the scoop on the state of Kate Middleton's pregnancy as a hoax or a prank?

The actions of the 2Day FM duo, however sophomoric, were a clear attempt to obtain confidential medical information about a hospital patient, and they used subterfuge – impersonation even – to do so.

This was not a laughing matter, even without the tragic twist we know all too well, the suicide of nurse Jacintha Saldanha.

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Medical files, whether they pertain to a princess or a pauper, are private, and we have a host of ethical, administrative and legislative provisions to protect the information.

That a patient's privacy was so easily breached by a couple of buffoons should lead us to ponder the challenges of handling health information properly. Tremendous pressures exist in the health system to make information easily accessible to facilitate care, while respecting individual patients' inalienable right to privacy.

While there should be no shame in undergoing medical treatment, the reality is that there is stigma associated with many medical conditions and treatments. People want to keep information secret to prevent everything from losing jobs to messing up relationships. Delicate issues can appear in a medical file: an abortion, a sexually transmitted disease, treatment for psychiatric illness, a history of drug use and so on.

Privacy is not a new concern. Confidentiality has been a concern since the advent of medicine. The Hippocratic oath – dating from the fifth century – reads: "I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know." This oath is sworn by physicians and other health-care professionals, but living up to it can be a challenge. Health workers are human; there is a temptation for some to snoop. Just last week, an employee of Vancouver Coastal Health was fired for accessing the health records of five media personalities out of curiosity. In 2007, after Hollywood actor George Clooney crashed his motorcycle in upstate New York, 40 employees at the hospital where he was treated were suspended for peeking at his file, and some even sold information to tabloids.

There are concerns that the move to electronic health records will make it easier to violate privacy, but these cases demonstrate that the opposite is true. The benefit of computerized records is that you can create privacy settings and track access, something that is impossible with paper files.

For other matters, protocols are in place. But put yourself in the shoes of the nurse or doctor who fields a call from a family member desperate for news on a loved one. Nobody wants to sound like a petty bureaucrat, whether they are taking a call from the Queen or from a distraught mom.

More concerning are the more nefarious attempts to violate privacy by insurers, employers, private investigators, police and current/ex-lovers.

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This was such a problem in the late 1970s that Ontario established the Commission of Inquiry into the Confidentiality of Health Information, headed by Mr. Justice Horace Krever (who would later head the inquiry on tainted blood).

It revealed a litany of inappropriate behaviour, including OHIP employees acting as double agents for private insurers (who used the information to deny claims), health workers selling medical files to insurers, employers and divorce lawyers, and police routinely accessing medical files to, among other things, mount smear campaigns against politicians.

Judge Krever made a number of recommendations to clean up the problem, but his overarching conclusion was that new laws were not really needed, what was required was that existing ethical standards and laws be enforced.

That remains true to this day.

In fact, research has shown that the No. 1 reason privacy is breached is health workers looking for dirt on their sexual partners, past and present.

Still, the vast majority of health professionals play by the rules. Yet, a scandal should serve as a reminder that in health care – where patients are vulnerable and their intimacies revealed – trust is essential.

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What that means, among other things, is that privacy is sacred and a culture of confidentiality must be the norm.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More


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