(2) X-ray technologists should be aware, however, of the facts that through
x-ray reports and case notes they have access to information about the patient, which
must always be regarded as confidential. Technically speaking, free discussion of the
patient's condition should be limited to the original triangle (primary physician,
radiographer, and patient). However, there are legitimate extensions of the triangle,
i.e., staff members with a legitimate need-to-know. Some discussion must necessarily
take place between various other members of the hospital staff: between junior
radiographers and their seniors, between radiographers and other nursing staff charged
with the patient's care, between radiologist and x-ray technologist.
(3) The triangle of confidence together with its legitimate extensions stops
there. No detail concerning a patient (medical or personal) should ever be discussed
with another patient or discussed outside the hospital. There is a natural desire to
discuss aspects of one's work, especially if one is truly committed. Care must be
taken, however, not to mention names if discussing a patient's case with family
members or others.
(4) It is tempting to appear knowledgeable about a well-known patient, e.g.,
a singer with a head injury, or a high-ranking official suffering from a nervous
breakdown. But care must be taken not to say more than might already have been
released to the press. With regard to the patient and the x-ray technologist, the triangle
of confidence is not a two-way street. The privileged communication is entirely one-
way in that the information is volunteered by the patient to the health care provider.
e. Ethical Responsibility. Every member of the health care team has an
ethical responsibility to preserve the confidentiality of the patient's personal and
medical information, and to keep such information from individuals outside the medical
community within the constraints of the law.
3-11. CONFIDENTIALITY: FACTS AND FICTION
In the modern hospital with its large and diversified health care team, its
bureaucracy, and third-party payers, a large number of people have legitimate needs
and responsibilities to examine the patient's chart. Most patients would probably be
surprised at the number of individuals legitimately privy to their medical affairs.6
Although most codes of ethics for health care professionals recognize the right to
confidentiality, the reality of confidentiality as applied in the modern hospital is quite
different from the ideal of the sacred triangle model of confidence (with its legitimate
extensions), outlined earlier. Patients recognize that physicians commonly discuss
cases for second opinions and they expect physicians to discuss things in more open
professional settings. However, they would be surprised at the extent to which cases
are discussed in medical journals, and more casually at parties, or with spouses and
friends.7
MD0067
3-17
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