By the end of postgraduate training, using a patient-centred approach and appropriate selectivity, a resident, considering the patient’s cultural and gender contexts, will be able to...
Today I was covering call for the Family Practice Teaching Service (aka the Family Medicine ward) at St Paul's Hospital. As I was rounding on a 103 year old female who was delirious and at the present moment, fast asleep, the granddaughter at the bedside shared with me how her grandma was doing that day and asked what we thought the prognosis was looking like. As I rounded on a 56 year old man with significant lethargy and paucity of words, his partner at the bedside began answering my questions on the patient's behalf; clearly he recognised his partner's significant weakness and wanted to be a voice of advocacy for him. As I rounded on a 92 year old Cantonese-only speaking female whom I had assessed on a previous call shift, I realised her family wasn't present as they usually are when I come by, which meant I wouldn't have my usual translators present.
What is and is not acceptable in the way of discussing patient health information with family and friends? I just got myself out of a major Google haze trying to find some answers. And you know when that happens either you weren't asking the right questions to get the answers you're looking for, or the information is really just not out there, which is kind of incredulous to believe as Google usually knows what's up. Maybe Google was just keeping things "confidential."
If you look up confidentiality, you can find a whole swath of information on the general ethical and medico-legal principles of confidentiality. However, to find guidance on the limits of just how much information sharing is acceptable and warranted when it comes to communicating with family members and other people in a patient's circle of care is apparently beyond my best Googling effort. If you're interested and have an incredible ability to focus on mundane reading, the Laws & Legislation webpage of the College of Physicians and Surgeons of British Columbia provides the legislation by which issues regarding confidentiality are interpreted in the courts, but again, there is little by way of detailed legislation regarding specifics of disclosure of patient information to family and other people involved in caring for a patient.
The most informative sources I found for guidance in navigating patient confidentiality with respect to disclosing health information to family and friends are:
The second resource is only two pages and while still general, is as much reading as I can handle on this dry but certainly important subject. The first resource is much less informative but highly relevant as it has provided me with 2 questions I can ask myself in real-time to decide what I ought and ought not to disclose to family and friends with respect to patient information. These are as follows:
It is my opinion that health care providers are much more competent at protecting patient confidentiality in the clinic as opposed to hospital environments. Unlike in clinics, in hospitals patients are often sharing rooms, such that patient information is discussed not behind closed doors, and patients also tend to be more vulnerable and thus may benefit more from the care of involved family and friends. But this is no excuse to be more lax when it comes to critically thinking about when and when not to breach patient confidentiality, and I think that I at least need to do better when it comes to making efforts to safeguard my patients' health information. Hopefully I will be able to use the 2 simple questions listed above to check-in before proceeding to discuss patient health information at the bedside, at the very least ensuring I've done my due diligence to consider how it may benefit or harm the patient and act in a more conscientious way for my own ethical, legal, and moral integrity.