Learning Activity: Confidentiality and Truth-telling Post test

1) What are the possible legal consequences of disclosing confidential clinical information without the patient's permission?

Legislation

Federal PIPEDA – mostly for organizations but also for individuals – fines and jail

Provincial – all provinces have privacy legislation – again mostly for organizations but fines and ?jail

Civil liability – docs have a duty of confidentiality – if they breach and harm results then they would be liable

2) Identify at least 2 core ethical principles that support the concept of physician-patient confidentiality

Respect for autonomy – people have right to control their personal information, we have a responsibility to them in that regard

Beneficence – in patients best interest to know information kept confidentiality – more likely to come and to disclose

[?get at history of confidentiality – Hippocratic Oath and Code of ethics -  maybe frame this in terms of ethical arguments rather than principles]

3) Name 4 clinical situations in which you are legally mandated to disclose what would otherwise be confidential clinical information, and identify who this information should be disclosed to.

Suspected child abuse/neglect – Child Protection authorities

Reportable diseases – Public Health

Reportable deaths – Medical examiner

Aviation/train safety – Aviation safety authority/minister of transport

Abuse of vulnerable person – mandated in some, permitted in all – varying definitions  (incapable or cognitively challenged)

4) Identify 3 clinical situations where the legal mandate to disclose clinical information varies significantly from province to province

Driver reporting – Most provinces mandated, Quebec and Alberta permitted, BC – if still driving after advised not to – to

Gunshot and stab wounds – vary from province to province

Elderly/persons in care/persons in LTC facility – vary from province to province

5) Describe at least one protocol or approach for breaking bad news/disclosing difficult information to patients and families

SPIKESS –

Setting (setting up the interview)

Perceptions (patient’s/family’s understanding so far)

Invitation (from patient to share the news)

Knowledge (provide the information and answer specific questions)

Empathy/Emotion (respond to the patient’s emotions)

Strategy and Summary