Privacy a General Practitioner’s Perspective

From the time patients give their personal information to practice staff to the time they tell the doctor all the confidential details of their medical and personal problems, they are potentially exposing themselves to breaches of their privacy. Patients place enormous trust in doctors and our staff, and it is up to us to ensure that we are worthy of their trust.

There are many situations where we need to stop and think about whether something we or our staff do (or don’t do) could, even in an extreme situation, lead to a breach of the patient’s privacy.

Think, for example, of the many situations in which we are asked to transfer information about a patient to another person:

• referral letters
• transfer of patient records to another doctor
• ‘innocent’ information requested by a third party.

Should we ask the patient’s permission to transfer each particular piece of information? What should we do when a patient requests that select pieces of information be kept from other providers? Is it part of our job to warn them of the risks of disclosing and not disclosing every piece of information that is normally contained in the referral letter?

The following are some situations that I have encountered in my general practice over recent months:

A physiotherapist or her receptionist rings to ask for a patient’s telephone number or new address, do you provide the details?
Arguably this would be permissible if it is within the patient’s reasonable expectations that his or her healthcare providers (including physiotherapist) would share such private information.

This can easily be ascertained by:

• asking the patient
• asking patients to review and sign a Practice Privacy Policy which expressly states that patients’ private information will be shared with other health professionals who are managing their care.

In the absence of the patient’s specific consent, the reason for the request from the physiotherapist will be of relevance. If the details were required to follow up care, it would be appropriate to release the information. If the details were required for research or marketing purposes, additional and specific consent from the patient would be required to release the information.

The father of a five year old patient rings and asks for a copy of his son’s medical records. The patient attends the practice with his mother and the parents are separated. Should you give the records to the father?

In general terms, either parent of a young child is able to obtain information about the medical management of their child. In the case of children who are not capable of giving consent, you can disclose health information to a “person who is responsible” for the child, including a parent. The Privacy Act does not specify that a parent must be a “custodial parent.”

However, exceptions may apply when there is a court order that grants sole responsibility for the medical care of the child to one parent, or where the medical practitioner believes disclosure of the information may pose a serious threat to the life or health of any individual.

After a patient dies, to what extent is it appropriate to discuss their medical history with their family members?

The Privacy Act does not apply to deceased persons. In this situation, each case should be considered on an individual basis. It may be appropriate to discuss a deceased patient’s medical history with their family for compassionate reasons, but information should not be disclosed if it is contrary to the known wishes of the deceased patient. In other situations, it may be necessary to obtain the written authority from the executor or administrator of the patient’s estate before releasing any information. This is especially important when there is a dispute about the patient’s will or estate.

A patient asks for a copy of the specialist’s letter about her. The letter contains nothing that you are unhappy to share with the patient. Do you give it to her?

The specialist’s letter should be given to the patient. Under the Privacy Act, patients have a right to access their medical records, including reports to and from specialists. This is regardless of whether or not the specialist’s letter states that it is not to be released to a third party without the permission of the specialist.

You refer a patient to a specialist and the patient asks that you do not include in the letter the fact that he/she is taking medication for genital herpes. What is the most appropriate response?

It is incumbent on the medical practitioner to discuss and impress upon the patient that the specialist needs to be aware of the full range of medications, and their relevant past medical history, in order to make an accurate assessment of the patient. This is especially the case if the information will be of direct relevance to the referral; for example, obstetric care where a past history of genital herpes may be of significance.

In some circumstances, particular information may not be relevant to the referral, and by agreement can be omitted from the letter to the specialist.