‘Confidentiality trumps everything’: how to maintain patient privacy when communicating with family members

A family member rings and asks if Mum has been to the doctor today? Saying yes, could be a breach of confidentiality. So when can privacy be breached, and what do you do if a son or daughter rings and asks for their parents cancer results? 

Imagine a situation where a family member calls a medical practice and asks if Mum had been to the doctor.

If this question was answered and the patient had not granted permission for this to be communicated with others, it would be a breach of confidentiality and could lead to a complaint.

Confidentiality is important in medical practice but can be a hard concept for family members to understand.

Dr Jon Fogarty, Medical Council hearing member and Central Coast GP, says confidentiality is the basis of the doctor’s relationship with a patient.

“Basically, except in unique circumstances, confidentiality trumps everything,” he said.

“One of the major exceptions to this is where you think the person is at risk to themselves or to others.’

He advised it is important, particularly with young patients, to establish through an early conversation that confidentiality exists except in rare circumstances.

“For example, a young person may have become psychotic and is a risk to themselves or others,” he said.

“He may say he’s going to kill his father. In that instance I would definitely break confidentiality.”

Privacy and confidentiality can be hard for families, who may want to discuss an aspect of their loved one’s health with the doctor.

If a son rang Dr Fogarty and asked about his father’s cancer results, he would not discuss the matter without the patient’s permission.

 “I would say I can’t discuss that without your father’s permission. But if you ask Dad to ring me and give permission, then I’m happy to have that conversation with you.”

Dr Fogarty acknowledges information from family and carers can be very useful to clinical management. That does not in itself lead to a breach in confidentially.

“I’m happy to take information from family and carers without formal agreement, but that doesn’t involve me divulging anything regarding the patient,” he said.

“Then families feel at least they are able to be heard without breaching confidentiality.”

As a manager of a medical practice, Dr Fogarty understands how important it is to communicate the need for confidentiality to all staff. 

“A family member could call reception asking if Mum has been to the doctor, but Mum may not want them to know,’ he said.

“It could be a casual remark, for example if a receptionist said: ‘your Mum came in and saw Dr Molly this morning. This is a breach of confidentiality.”

“This is particularly important in rural areas. There may be only one or two doctors making the need for confidentiality even greater...”

Professor Anthony Eyers, a colorectal surgeon with more than 30 years’ experience, said as long as the patient has capacity, they are the only person who makes the decision about their health.

 

Further resources

Good medical practice: a code of conduct for doctors in Australia. Chapter 3: Working with patients

https://www.medicalboard.gov.au/codes-guidelines-policies/code-of-conduc...

 

NSW Health Privacy Manual for Personal Information

https://www.health.nsw.gov.au/policies/manuals/Pages/privacy-manual-for-...

 

Navigating Ethics of Physician-Patient Confidentiality: A Communication Privacy Management Analysis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523934/

 

Office of the Australian Information Commissioner: Using and disclosing health information 

https://www.oaic.gov.au/privacy/guidance-and-advice/guide-to-health-privacy/chapter-3-using-or-disclosing-health-information/

 

Office of the Australian Information Commissioner:  Disclosing information about patients with impaired capacity

https://www.oaic.gov.au/privacy/guidance-and-advice/guide-to-health-privacy/chapter-7-disclosing-information-about-patients-with-impaired-capacity/