Of late, there has been a lot of discussion on the importance of the confidentiality clause that exists between a patient or those seeking treatment and the medical provider. Is there a written clause on the same, and under what circumstances can it be broken under law?
Patient-doctor confidentiality is a requirement to protect the privacy of all clients, says therapist Kamna Chhibber, head of department, Mental Health and Behavioral Sciences, Fortis Memorial Research Institute, Gurugram. “It is not just related to the content of what may be discussed in a therapy session but also the fact that a client is in therapy with a therapist. Trusting and believing that a therapist would protect all that is being shared can be difficult and the aspect of confidentiality contributes towards and ensures that a client is able to maintain trust in the process and can share aspects of their experiences and life that they may otherwise not be most comfortable in discussing,” she said.
In India, there are two specific provisions which forbid doctors from disclosing any information relating to a patient. As per The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, section 2.2 Patience, Delicacy and Secrecy, “confidences concerning individual or domestic life entrusted by patients to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed”.
Also, as per The Indian Evidence Act, 1872, ‘the proof of good faith in transactions where one party is in relation of active confidence’, that is the care provider (in such case), binds the doctors from disclosing the details of a case.
“Even though it is not an oath, people are coming forward to seek help with a lot of trust. The conversation around mental health has started getting better by the day. It requires a tremendous amount of effort for someone to seek help. A breach of confidentiality can hamper that process,” observed counselling psychologist Anu Goel.
While all health professionals are bound to keep the patient’s information obtained during care or treatment confidential, the code of ethics, which is not absolute in nature, also outlines certain exceptions like the need for involvement of other health professionals for improvement in treatment, or to ensure safety of the patient from themselves, or when asked by a court of law. It states, as per Rule 7.14 the physician “shall not disclose the secrets of a patient that have been learnt in the exercise of his/her profession except in a court of law under orders of the Presiding Judge; in circumstances where there is a serious and identified risk to a specific person and/or community; [or in case of] notifiable diseases.”
In simple terms, giving information to a patient is not normally a problem; giving information to relatives, or an unrelated third party is almost always problematic, noted author J M Watwe in the Indian Journal of Medical Ethics in a 1998-article titled Disclosure of confidential medical information.
For instance, without informing the patient or the next of kin, if the healthcare provider goes public, it is not “ethical”, noted Goel. “The question of ethics does become important in a case-to-case basis. Few years back, someone I was treating committed suicide within six months at her home. The blame was pinned on the husband. Since the patient was suffering from bipolar disorder, I had to give a full letter disclosing the case details for justice to prevail because the husband requested me,” shared Goel.
Chhibber asserted how the obligation is always to the client or patient first. “Disclosure should have taken into account the impact it would gave on the larger collective and ideally should have be avoided unless it was sought by a court of law,” she remarked.
And how does disclosure impact the larger push for seeking help, especially in mental health cases? “Upholding the rules and values of the medical profession is of quintessential importance to maintain the faith and belief that individuals have in mental health professionals. Mental health has seen various difficulties, stigmas and stereotypes and it is pertinent that we ensure all measures are taken to ensure that mental health and professionals working in this field are taken seriously and seen as experts who are there to support and provide the right mechanisms for change and selfcare,” mentioned Chhibber.
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