The principle of confidentiality obliges us health professionals to respect the confidential information that patients share with us. By extension, we are also obligated to keep confidential information that we might gain from sources other than the patient in our care, e.g., medical records or other health professionals. Every patient has the right to Dignity (Section 10), freedom and security of the person (Section 12) and privacy (Section 14), as contained in the Bill of Rights in the South African Constitution, Act 108 of 1996, however certain circumstances strike a sense of scepticism to health professionals owing to the need to share the information of the patient amid other health professionals predominant for the benefit of the patient.

The incidence transpired in the clinical block that I’m currently placed at, where I met a patient that is a very passionate athlete; willing to stop at nothing to thrive in her sport career.

From my examination with the patient, I identified that she has Femoroacetabular impingement (FAI) which has now become an impediment in her running as running aggravates the unpleasant symptoms around her joint like severe pain and stiffness etc. I took it upon myself as her therapist to decipher the concept of FAI and its possible implications. In my explanation, I disclosed the possibility of going through surgery which would imply that she stays off the field for a while. In her response, the first thing she mentioned was her inability to be off ground as there would be vexatious consequences such as losing her sport’s scholarship. She further asked me not to disclose the information to my seniors, which is the next step I had aforementioned I will take.

At that moment, I felt stuck in between two most crucial concepts in a clinical setting: respecting the wishes of the patient (and compromise their health in this case) or disclose the information to my senior (for re-assessment and their opinion). I was overflowing with controversial thoughts, knowing that the moment a patient feels that their right to privacy, dignity etc. is not protected and they are not being treated with the respect they deserve, the situation can quickly escalate into a legal matter which can cause unnecessary problems for me and potentially affect my premature registration at the HPCSA.

In my venture to reach a decision, I spoke to one of my colleagues (without disclosing any patient information) about what they would do in a similar situation as me.  And my co-worker mentioned something very tonic and foremost but biased, that sometimes we need to go extra extremities as against our patients wishes to ensure they get the superlative health care they need. Even though her opinion was biased, I had also decided to include a superior reason being that if anything happens to my patient as she persistently runs, I would have cleared my name. Consequently, I let my superior know of the patient and the principal concerned at hand.

After I had told my senior about the patient and the entire situation I felt very bad because I’m enlightened that confidentiality is a core element of all human relationships and, so, is basic to building trust between patients and health professionals. Keeping confidences is a form of keeping a promise or bond. In effect, the health professional promises the patient that they will keep a bond of trust – the patient trusts the health professional to keep confidence and the health professional trusts the patient to tell the truth, however, others, for example Brazier and Cave (2007, p.80) argue that paternalistic motives to protect the patient cannot justify the sharing of information about a patient with capacity without the patient’s consent.

CLINICAL DILEMMA

Confidentiality is a core element of all human relationships and, so, is basic to building trust between patients and health professionals. Keeping confidences is a form of keeping a promise or bond. In effect, the health professional promises the patient that they will keep a bond of trust – the patient trusts the health professional to keep confidence and the health professional trusts the patient to tell the truth (Allen, 2014), however, HPCSA (2014) states that circumstances may arise where a patient cannot be informed about the sharing of information, for example because of a medical emergency. In these cases the health care practitioner should disclose the relevant information promptly to those providing the patients’ care, and that is precisely what I did, even though the patient had asked that I do not disclose the information because I felt the condition of my patient requires a sense of agency as the FAI is presently affecting multiple structures.

References

The Bill of Rights in the South African Constitution, Act 108 Of 1996

Allen, A. (2004). Privacy in health care. In S. G. Post (Ed.), Encyclopaedia of bioethics (3rd ed., Vol. 4, pp. 2120-2130). New York: Macmillan.

Brazier, M., & Cave, E. (2007). Medicine, patients and the law (4th ed.). London: Penguin books.