Healthcare professionals have a fiduciary duty to maintain patient-practitioner confidentiality. Patients are bound to reveal very intimate information during a treatment or consultation session in order to obtain appropriate health care. Thus, nurses are expected to exercise a high level of professionalism by ensuring that the information does not get into the wrong hands. Different professionals in healthcare institutions can exchange such information if they deem it necessary for the well-being of the patient. The technological era has brought about a big revolution in the protection of medical information. Individuals have the ability to access previously inaccessible data within a short period of time especially through the internet. Therefore, healthcare professionals have a harder task of maintaining ethical competence in order not to be in violation of the law due to extenuating circumstances such as those imposed by hackers. Healthcare providers have to adhere to several policies such as AHPRA, the Privacy Act of 1988 and the stipulated Code of Conduct according to the American Nursing Association to avoid stipulated repercussions. Professionals that intently disclose confidential information are eligible for punishment and compensatory actions towards their clients as well as their institutions of practice.
Confidentiality agreements between healthcare practitioners and their patients can be implicit or explicit, but either way they exercise this right with the expectation that the information is not disclosed (Zucker et al., 2019) The confidential status of the information needed for healthcare providers to conduct physical and psychological examination is conveyed with a level of trust. Due to the possibility of healthcare providers to share medical information about their patients with the general public forces individuals to holdback critical information about their medical past. Essentially, people fail to present personal information about their medical conditions for fear of being criticized, discriminated against or segregated from the rest of the society (Zucker et al., 2019). Individuals on the public scene such as politics and social media are most affected by information that falls onto malevolent individuals.
However, confidentiality should not be mistaken for privacy although the two words are used interchangeably even in the case of high profile patients such as politicians. Privacy relates to an Individual in a personal and their right to freedom unwanted intrusion (DeJong, 2014) It is mostly associated with the person’s life and not really associated with healthcare provision or professionals. People draw the line between privacy and confidentiality in varying degrees depending on their culture and their innate beliefs on how much people need to know. Nevertheless, healthcare professionals enjoy the privilege of stepping into both the private and confidential zones in order to develop comprehensive treatments specific to the client (Sheikhtaheri et al., 2019). Professionals develop medical records that handle all the medical history relevant to the well-being of the client even in future events where the client may not be in a position of providing the information personally.
In the healthcare setting, privacy and confidentiality can be distinguished by the privileged clients whose information is protected by the law while that of the practitioners is not. Consequently, ). clients are most likely to disclose information they learn about their designated healthcare provider which practitioners would also not prefer to be public knowledge. Patients have the freedom to talk about their physicians and their treatment with other people in society such as their families, friends and neighbors while healthcare practitioners are legally obliged to exercise professionalism (Sheikhtaheri et al., 2019). Healthcare providers are also susceptible to being accused of unethical behavior even while venting after having a long day’s work (Albsoul et al., 2019). This creates a major loop hole in confidentiality in healthcare which should be considered in policies in order to ensure that both privacy and confidentiality are reciprocated in order to curtail malicious acts from both parties.
Unlike healthcare professionals, clients’ rights and privileges are included in the Australian National Law as part of the Health Practitioner Regulation National Law. The law stipulates the minimum standards that practitioners should exercise in the line of duty concerning electronic Commented [JD4]: I am unsure as to the relevance of this How does it link to the purpose of your essay?? Commented [JD5]: Again what is the relevance of this to the purpose of your essay?? 3 exchange, security of health information and general privacy (Ferguson, 2017). The law imposes confidentiality among staff members in the Australian Health Practitioner Regulation Agency (AHPRA). More recently, the government implemented the ‘Privacy Rule’ into the AHPRA which applies to healthcare providers that provide medical information electronically (Ferguson, 2017). All health information must be considered regardless of it’s mode of transmission whether orally, on paper or electronically through social media Platforms as well as blogs. As much as many healthcare professionals may be well-intentioned while publishing medical blogs for public education, there are practitioners that may disseminate health information that may end up as slanderous to a patient. Despite the good-intentions, Curtailing actions that result in embarrassment of an identifiable patient holds much priority in the AHPRA. This regulation provides guidelines and repercussions of violating protected health information.
Clearly, technology and the internet have made confidentiality violations in healthcare extremely common especially with the virtual ‘cloud’ storage of electronic data. The internet has literally made most information non-confidential with the easy-to-access computers and smartphones (Bani Issa et al., 2020). Currently, the internet has the ability to increase viewership exponentially, and information that was only intended for a few people or groups can end up being global knowledge. Unfortunately, issues of cybercrime have become common including hackers, use of Trojan horse and bugging computer with viruses (Bani Issa et al., 2020). Therefore, malicious activity by healthcare professionals can range from issues that they have no control of such as hacking, all the way to their individual thoughtlessness and malevolence. Failure to maintain patient information confidentiality can lead to legal action against the healthcare professional as well as the institution, termination of employment or the suspension of medical license.
On top of creating restrictions with the type of health information that can be disseminated, AHPRA also has provisions that require healthcare providers to disclose their channel of communication (Ferguson, 2017). For technological communications, potential breaches of confidentiality are more eminent, evident and destructive to patients and communication need to be made explicit (DeJong, 2014). Revisions of the AHPRA regulations due to modern technological innovations require that practices to give clients privacy notices prior to publication that include procedures and breach avoidance as well as conduct privacy security risk assessment (Ferguson, 2017; Albsoul et al., 2019). This way, client’s whose medical history is at risk of exposure can withhold consent if the information is quite explicit. Alternatively, the clients are able to offer consent if the information conveyed cannot be traced back to the specific patient.
Review of the Case Study
In our case study, the healthcare practitioner decided to vent using an online blog leading up to what appears to be ‘patient-identifying information’ since their identity could be inferred. In a much larger or urban community, chances of healthcare practitioners meeting the same patient within hours are extremely low. Thus, the provider could not have been in violation of AHPRA regulations. However, since we have worked together for a while the practitioner finds that they are in AHPRA violation in a smaller setting (Ferguson, 2017). In this case, the impact on breaching confidential client information may be minimal but in general I would personally assume that the neurologist enters the room with preformed biases about the patient in question. Additionally, the negative venting on the online platform reflects negatively on the healthcare practitioner individually as well as to the entire medical profession in general.
Strong feelings and emotions in most cases result in the loss of good judgment. When individuals are angry, sad, frustrated, overwhelmed or resentful, they may publish content that they would not consider posting while they are in a much calmer state of mind. This happens when practitioners come from a hectic day in their workplace, for instance, losing a patient or arguing with a sub specialist about an ineffective treatment (DeJong, 2014; Wolf & Mendelson, 2019). Consequently, such behavior can contribute to a breach of professionalism and AHPRA violations. Since healthcare professionals are also human beings, it is recommendable to approach a fellow colleague or supervisor with whom they can vent to and talk. Other times bad judgment can be masked with humor (Wolf & Mendelson, 2019). One man’s meat can quickly become another man’s poison especially when it involves confidential information.
Ethical Decision Making Framework
To address and mitigate the issue of healthcare professionals violating AHPRA rules and regulations about confidentiality, Michael McDonald together with his colleagues formed a decision-making framework aimed at upholding ethics in medical educational materials. The framework is especially helpful during this technological era where everyone has access to the internet. The gradual steps ensure that prior to posting a script on the online platforms including blogs and social media, the healthcare provider is able to account for any risks involved in the information that they intend to disclose (McDonald & Then, 2019). Here is the step-oriented analysis of the scenario depicted in the case study on confidentiality in healthcare.
The first step involves collecting information and identifying the issue. It is important that healthcare professionals be on high alert in order to demonstrate sensitivity in case of morally charged situations (McDonald & Then, 2019). This can be achieved by making use of ethical resources to determine appropriate moral standards such as the innate moral intuition. At this point, the moral intuition is guided by different perspectives that the provider has to consider. The healthcare provider must ensure that they appreciate the perspectives of the patient, their families, other healthcare professionals as well as the administrators, hence, major decisions need to be made before the full story is developed in order to come up with as much relevant and morally standard information. It is at this stage that the practitioner becomes aware if they are in a situation where there is a conflict of interest.
As a healthcare professional, eliminating conflicts of interest need factoring in clinical issues, preferences of the patient, quality of life and contextual features. Clinical issues include, the clients medical history, nature of the medical issue (chronic or acute), goals of treatment, probabilities of success and alternative plans in case of failure (Farrugia et al, 2021). While considering the patient’s preferences for treatment, the provider firstly has to consider the client’s opinion. Secondly, the provider must ensure that the opinion is well informed about the risks and benefits accompanied with the treatment approach. Thirdly, the client should be legally competent to make a decision based on their psychological and physical states. Finally, the healthcare workers should consider the level of cooperation influenced or hindered by religious beliefs or cultural aspects (Farrugia et al, 2021). After making discovery of all these issues in a specific client, healthcare professionals are able to discern whether there is any justification for the breach of confidentiality. During the second stage of decision making, the healthcare workers specify on feasible alternatives to the patient as well as other decision-makers that may be involved. In this step, providers should be keen to take into account good and bad consequences for all prospective parties including the medical profession and organizations (McDonald & Then, 2019). Honesty personal stake in the medical outcome is mostly encouraged in order to motivate others in taking a similar approach.
The final and the most significant step involves utilizing ethical resources to identify morally significant factors in each alternative. The first resource is the readily available ethical principles of nursing in healthcare including autonomy, non-maleficence, beneficence, justice and fidelity (McDonald & Then, 2019). Autonomy implies that the clients are in a position to make decisions independently. This means that healthcare providers should endeavor to ensure that they enrich the patient with the relevant information and does not influence the final decision of the nurse. Non-maleficence implies that healthcare professionals are not expected to do harm to clients intentionally. They are bound to provide standard care that minimizes or avoids risks in regard to medical competence (McDonald & Then, 2019). Beneficence is defined as charity and kindness that requires healthcare providers to act in a manner that benefits others (McDonald & Then, 2019). Justice is simply being fair and impartial regardless of age, gender, ethnicity or sexual orientation. Fidelity implies that the practitioner should show notions of loyalty in order also for the client to trust and share information as well as have faith in the therapeutic relationship for progress to take place(McDonald & Then, 2019). Therefore, posting a medical script is not only dependent on the publisher but also other stakeholders playing a role in the clients well-being. Holding discussions with associates and trusted friends can provide invaluable insight on how to uphold and maintain patient as well as employer confidentiality (McDonald & Then, 2019).
However, the framework is expected to act as a guideline rather than a recipe for making ethical decisions. Considering the neurosurgical physician that published an article of the identifiable ‘difficult patient’, the physician was in violation of AHPRA Confidentiality Law (Wallis et al., 2018). This is because she did not exercise discretion although she intended on providing relevant information to others. Since healthcare practitioners report cases of breaching confidentiality on online platforms, such a matter should be presented to the administration to avoid further incidents and even legal sanction on the organization (Wallis et al., 2018).
Conclusion
Confidentiality in healthcare is a very important aspect as a practicing healthcare professional. In order to treat a patient efficiently, they must disclose intimate information about themselves that they trust will not be shared without their consent. Unfortunately, cases of breaching Confidentiality have become common with the transition to the technological era with computers and smartphones that connect to the client internet. Hence, healthcare workers are forced to be extra careful when disclosing information on the internet about their patients due to the high risk of it getting into the wrong hands. At times, the leaking of information goes beyond the control of healthcare workers especially when malicious hackers are involved. Nevertheless, healthcare providers can also thoughtlessly expose critical information with an aim of being humorous. Therefore, healthcare professionals can make use of the ethical decision making framework to come up with scripts that are free of risk of breaching confidentiality. With 9 the help of the framework, practitioners can gain better insight on ways to maintain integrity and professionalism in their daily practice to avoid the severe repercussions laid out by the Australian National Law.
References
Albsoul, R., FitzGerald, G., Finucane, J., & Borkoles, E. (2019). Factors influencing missed nursing care in public hospitals in Australia: An exploratory mixed methods study. The International Journal of Health Planning and Management, 34(4). https://doi.org/10.1002/hpm.2898
Bani Issa, W., Al Akour, I., Ibrahim, A., Almarzouqi, A., Abbas, S., Hisham, F., & Griffiths, J. (2020). Privacy, confidentiality, security and patient safety concerns about electronic health records. International nursing review, 67(2), 218-230.
DeJong, S. M. 2014, ‘Chapter four – confidentiality’, in Blogs and Tweets, Texting and Friending: Social Media and Online Professionalism in Healthcare, pp. 47-60.
Farrugia, A., Pienaar, K., Fraser, S., Edwards, M., & Madden, A. (2021). Basic care as exceptional care: Addiction stigma and consumer accounts of quality healthcare in Australia. Health Sociology Review, 30(2), 95-110.
Ferguson, C. (2017). Nursing and social media. Contexts of Nursing: An Introduction, 4, 61-77.
McDonald, F. & Then, S. N. 2019, Ethics, Law & Health Care: A guide for Nurses and Midwives, 2nd edn, MacMillan International, Red Globe Press.
Sheikhtaheri, A., Hashemi, N., & Hashemi, N. S. (2019). Performance of Hospitals in Protecting the Confidentiality and Information Security of Patients in Health Information Departments. In dHealth (pp. 202-209).
Wallis, K. A., Eggleton, K. S., Dovey, S. M., Leitch, S., Cunningham, W. K., & Williamson, M. I. (2018). Research using electronic health records: Balancing confidentiality and public good. Journal of Primary Health Care, 10(4), 288-291.
Wolf, G., & Mendelson, D. (2019). The my health record system: Potential to undermine the paradigm of patient confidentiality?. University of New South Wales Law Journal, The, 42(2), 619-651.
Zucker, N. A., Schmitt, C., DeJonckheere, M. J., Nichols, L. P., Plegue, M. A., & Chang, T. (2019). Confidentiality in the doctor-patient relationship: Perspectives of youth ages 14-24 years. The Journal of Pediatrics, 213, 196-202.
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