The focus of Unit 14 is on patient confidentiality.

Learning Objective: By the end of this unit, you will be able to recognize ethical and legal obligations regarding patient confidentiality, understand the general principles of confidentiality, and identify appropriate situations where breaching confidentiality is justified.

Confidentiality

Definition

Patient confidentiality refers to the obligation of healthcare professionals to keep a patient’s personal and medical information private unless consent is given for disclosure.

General principles of confidentiality

1. Patient information should only be shared on a need-to-know basis.
2. Confidentiality applies to all forms of patient data (written, verbal, electronic).
3. Breaching confidentiality should only occur under specific ethical and legal circumstances.

Pause for Thought

Think about a time when you were trusted with sensitive information. How did you handle it?

Consider why maintaining confidentiality is critical in healthcare.

Ethical considerations

Respect for patient autonomy and dignity.

Trust-building between healthcare providers and patients.

Ethical guidelines established by professional bodies.

Legal obligations

In the countries of the partners of this project (Czech Republic, Germany, Ireland, Poland) patient confidentiality and the protection of personal health data are regulated by national laws as well as European Union regulations.

The relevant laws and regulations in each of these countries:

In Czech Republic – the GDPR and the Health Services Act

In Germany – the Federal Data Protection Act (BDSG) and GDPR

In Ireland – the Data Protection Act 2018 (based on GDPR)

In Poland – the GDPR (RODO) and the Personal Data Protection Act of 2018

Healthcare professionals must comply with these laws.

Unauthorized disclosure can lead to legal penalties and professional consequences.

Pause for Thought

 A nurse accidentally overhears a colleague discussing a patient’s case in a public cafeteria. What ethical and legal issues arise in this situation?

Exceptions to confidentiality

1. Risk of harm to the patient or others (e.g., suicidal intent, threats of violence, mental issues).
2. Legal requirements (e.g., reporting infectious diseases, child abuse, elder abuse).
3. Court orders requiring disclosure of patient records.
4. Public interest concerns (e.g., preventing the spread of communicable diseases).

Key considerations before breaching confidentiality

Have all alternative solutions been explored?

Is the breach necessary to prevent serious harm?

Is disclosure limited to the minimum necessary information?

Pause for Thought

A patient confides in you about experiencing domestic abuse but asks you not to tell anyone. What steps should you take in this situation while balancing confidentiality and patient safety?

Balancing relatives’ concerns with a patient’s right to privacy

Balancing relatives’ concerns with a patient’s right to privacy is a delicate issue in healthcare setting where emotional, legal and ethical considerations intersect. While families may want to be informed, their right to know is limited by the patient’s right to confidentiality.

How to do it

1. Before the conversation, make sure you know what information the patient has agreed to share and what they prefer to keep private.
2. Be familiar with any legal requirements or guidelines that pertain to sharing patient information, such as patient consent, healthcare regulations and professional ethical standards.
3. If you are mediating – maintain a neutral stance throughout the conversation. Your role is to mediate, not take sides.
4. Acknowledge the family’s concerns. Understand that family members may experience frustration, anger or anxiety, especially if they feel excluded from important decisions. Respond with empathy and patience and offer reassurance that the patient’s best interests are the priority.
5. Make sure they know who to turn to if they need further clarification or assistance in the future.

Key Takeaways

• Healthcare professionals must keep patient information private unless the patient consents to its disclosure.
• Share information only on a need-to-know basis.
• Breaching confidentiality is only justified under specific circumstances.
• Unauthorized disclosure can result in legal and professional consequences.
• Be neutral, empathetic, and patient when addressing family concerns.

Next Steps

• Do the exercises.
• Watch illustrative videos accompanying Simulation 14.
• Participate in Role-play Simulation 14 to practise communicating with concerned relatives in the context of patient confidentiality.
• Share reflections and key takeaways during debrief.