(1) Infringement of confidentiality. An infringement of confidentiality occurs
when information disclosed by the patient, in confidence, to the health care practitioner
is purposely revealed or inadequately protected.
(2) Infringement of privacy. An infringement of privacy occurs, on the other
hand, if an unauthorized person gains access to information through means other than
the direct and privileged confidence of the provider- patient relationship.
A BREACH OF CONFIDENTIALITY
A 19-year old woman comes to the x-ray clinic for x-rays. When asked if she is
pregnant, she replies in the affirmative. She tells the radiographer that she does not
want her husband to know about the pregnancy.
If, for some reason, the radiographer disclosed this privileged information to the
woman's spouse, it would constitute a breach of confidentiality. It would only be
appropriate to disclose information such as this to individuals with a legitimate need-
to-know, such as the radiologist.
A BREACH OF PRIVACY
If an individual sneaks into a hospital record room, breaks into a hospital computer
bank, or overhears information in a hospital corridor, a breach of privacy has
occurred. The information was not obtained through the privileged physician-patient
relationship, but through unethical means and without a legitimate need-to-know.
c. Access vs Secrecy. A contradiction between access and secrecy has
existed since the beginning of medicine. Most health profession ethics standards
recognize this contradiction. The Hippocratic Oath of Physicians states the following:
"Whatsoever, in connection with my professional practice or not in connection
with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I
will not divulge, as reckoning that all such should be kept secret."
This ideal of the privileged nature of disclosures within the physician-patient
relationship soon came into conflict with laws requiring disclosure. The legal
obligations of health care providers place external limits on confidentiality. The
patient's confidentiality is, of necessity, less strictly observed within the health care
community, as providers have a legitimate right to access. Confidentiality is more
strictly observed when dealing with parties outside the health care community,
individuals not having a legitimate need-to-know. There are recognized exceptions to
the kind of information that can be considered confidential. For example, information
on births and deaths must, by law, be routinely reported to health care agencies.
Gunshot wounds and sexually transmitted diseases usually have to be reported to the
public health department. The American Medical Association has revised its code to