Disclosure of information to others providing care [1]

Most patients understand that health information needs to be shared within the healthcare team in order to provide an adequate level of care. Practitioners cannot treat patients safely, nor provide continuity of care without receiving and giving relevant information about the patient’s condition, medical history and treatment.[2]

This could take the form of information being provided to another healthcare practitioner through the transfer of patient files, or a referral letter typed by support staff.

Healthcare practitioners should, however, make sure that patients are aware that personal information about them will be shared within the healthcare team. Patients must be given reasons for this.[3]

It is particularly important to check that patients understand what will be disclosed if it is necessary to share personal information with anyone employed by another organisation or agency providing health or social care.[4]

The Guidelines provide that in certain circumstances, express consent is not usually needed before relevant personal information is shared to enable the treatment to be provided.[5] The example is given of where a general practitioner discloses relevant personal information to a medical secretary, so that she can type a referral letter. The Guidelines comment that, in such circumstances, when the practitioner informs the patient that he or she is referring the patient to someone else, the patient is assumed to have given implied consent to such disclosure being made to the secretary.[6]

The National Health Act specifically deals with circumstances in which a practitioner can disclose information. These provisions include transfer of information within a healthcare team, between healthcare professionals providing care and for local clinical audits.

The healthcare practitioner must make sure that any person to whom personal information about patients is disclosed, understands that it is given to them in confidence, which must be respected.[7]

Any person receiving personal information in order to provide care is bound by the legal duty of confidentiality, whether or not they have contractual or professional obligations to protect confidentiality.[8]

Particular precautions

There are circumstances where particular precautions need to be taken when dealing with the confidentiality of healthcare information. An example of such circumstances is a practice which is located in a small town. These have tight knit communities, and the practitioner would be well advised to pay particular attention to measures which could protect the confidentiality of patients’ information. This would include paying attention to the training and terms of employment of members of staff.

As a general rule, express, written consent should be obtained where there is doubt about the appropriateness of sharing confidential information.

Patient refusal

Occasionally, challenges may be encountered where a patient refuses to allow disclosure of information to other members of a
healthcare team which is necessary to ensure appropriate treatment. Where this is an informed decision on the part of the patient, the refusal must be respected. In such circumstances, practitioners are advised to discuss the matter with the patient and attempt to obtain consent once the full implications of the patient’s decisions are made known to him or her.

The situation where it is only the patient’s health and life which is at risk is therefore fairly straight forward. A more complex
situation arises where the health and life of other people are potentially affected.

[1]
Paragraph 7, HPCSA Guidelines for Good Practice in the Healthcare Professions, Booklet 5, Confidentiality: Protecting and Providing Information

[2] Paragraph 7.1, Booklet 5, Confidentiality: Protecting and Providing Information

[3] Paragraph 7.1, Booklet 5, Confidentiality: Protecting and Providing Information

[4] Paragraph 7.1, Booklet 5, Confidentiality: Protecting and Providing Information

[5] Paragraph 7.2, Booklet 5, Confidentiality: Protecting and Providing Information

[6] Paragraph 7.2, Booklet 5, Confidentiality: Protecting and Providing Information

[7] Paragraph 7.3, Booklet 5, Confidentiality: Protecting and Providing Information

[8] Paragraph 7.3, Booklet 5, Confidentiality: Protecting and Providing Information.