A doctor-patient relationship (DPR) is considered the most important element in medical ethics. DPR is typically formed when a physician attends to a patient's medical needs in a pleasant manner through check-ups, diagnosis, and treatment. Because of the relationship, the doctor owes it to the patient to successfully treat the ailment or end the relationship. Primary care physicians, in particular, must develop a satisfactory DPR in order to provide excellent health care to patients.
Since these relationships frequently involve highly personal and sensitive information (such as medical conditions or personal finances), confidentiality allows for open and honest communication between the parties involved. As a result, confidentiality serves the best interests of all parties involved.
What is Doctor-Patient Confidentiality?
Medical confidentiality is the practice of doctors keeping all information received during the course of a patient's treatment private.[1]
But why this confidentiality is important?
The goal of this confidentiality is to make patients feel comfortable enough to provide any and all information necessary for proper medical care. Receiving information in this manner aids the doctor in making an accurate diagnosis. It enables the doctor to provide the best possible medical care to the patient.
Thus, when a doctor accepts a patient, there is an expectation that the doctor will keep that special knowledge confidential and use it solely for the benefit of the patient. Without the patient's permission, the doctor may not disclose any medical information about the patient to third parties.
The exception to such Confidentiality?
The patient's medical information given to a health care provider shall not be disclosed to others unless the patient gives his consent to do so. However, there are some exceptions to this rule for example Issues concerning health insurance, if confidential information is at issue in a lawsuit or when doctors share medical information with others and refer to it as one of their case studies. However, if this information is published in professional journals, the patient's identity is never revealed, and the patient has the right to sue if it appears in any way.[2]
Also, if the patient is not of legal age or is mentally incapacitated, the information can be disclosed to his parents or guardian.
What Is The Difference Between Privacy And Confidentiality?
Privacy protects the patient's identity, because of keeping medical records restricted or in a vault from public release. If such personal medical information reaches an unauthorized third party and the identity of a patient is determined or known without the patient's consent, the patient may take legal action.
Confidentiality, on the other hand, applies to data. It refers to the right of an individual to have personal and detectable medical information that is kept private between the patient and the physician. It is an extension of Privacy.[3]
Right of Confidentiality
There are numerous rights that the patient has and can exercise whenever necessary. Some of the rights include:
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Right to adequate medical care and humane treatment,
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Right to information,
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Right to choose a health care provider and facility,
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Right to medical records,
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Right to privacy and confidentiality, and so on.
Laws governing the Confidentiality and Privacy of a patient in India
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The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Rules, 2002 states in chapter 7- (7.14) that a registered medical practitioner is not allowed to share any patient information that was learned during the course of providing care or while using their professional judgement.
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The implications of the violation are discussed in Chapter 8.2 of the rules. The appropriate medical council will hold an inquiry if a complaint is made about the professional misconduct of a registered medical practitioner and that complaint is brought before the Medical Council of Disciplinary Action, and will also give the registered medical practitioner the opportunity to be heard in person or by a pleader after receiving the complaint.
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And suppose the registered medical practitioner is found to have engaged in professional misconduct during the course of the investigation or proceeding. In that case, the Medical Council will punish him accordingly, or they may even order his removal.
There are no specific regulations in India that protect the privacy and confidentiality of patient data other than the code of ethics.
Case Laws
Mr X v. Hospital Z, 1998[4]
In this case, the respondent took a sample of the appellant's blood because it was going to be transfused to another person. The appellant's blood sample report revealed that the appellant is HIV positive. So, the appellant's marriage was annulled because hospital administrators disclosed information to his family without his express permission, and somehow the information also reached the girl's family.
The Court held that the responsibility to keep the doctor-patient information private is not absolute and can be breached for the public welfare or interest. Hence, the respondent was found not guilty for the same reason.
But the Court found the appellant guilty under Sections 269 and 270 of the Indian Criminal Code since he knew he had a venereal illness but still chose to get married.
Mr Surupsingh Hrya Naik v. State of Maharashtra, 2007[5]
The Medical Council Code of Ethics and the Right to Information Act of 2005 were in conflict in this case. In this case, it was argued that making health records public under the Right to Information Act would violate the right to privacy. In this case, the Bombay High Court ruled that the Right to Information supersedes the Right to Privacy and Confidentiality.
Conclusion
Confidentiality plays a vital role in building and developing trust in Doctor- Patent Relationship. Even an individual's treatment is dependent on confidentiality; the more trust he has, the more he can tell his doctor about his problem. So, maintaining privacy should be of the utmost priority in Doctor-Patient Relationship. However, In India, we only have Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 that regulate this relationship and confidentiality. There is no specific act to protect this right of confidentiality of patients. There are gaps that need to fill for example Right to Information prevails over the Right to Confidentiality which means anyone can avail information by the way of the Right to Information Act.
In case of a breach of confidentiality, a patient can take legal action against the practitioner, however, a proper framework and specific regulation is the need of an hour to fill the gaps and make the foundation of such rights stronger and more powerful.
[1] Kant, P. (2019). Law on Consent and Confidentiality in India. Legal Service India. https://www.legalserviceindia.com/legal/article-6973-law-on-consent-and-confidentiality-in-india.html
[2] FindLaw. (2021). Breaches of Doctor-Patient Confidentiality. FindLaw. https://www.findlaw.com/injury/medical-malpractice/breaches-of-doctor-patient-confidentiality.html.
[3]Encyclopedia of Surgery Editorial Team. (2021). Patient Confidentiality. In Surgery Encyclopedia. https://www.surgeryencyclopedia.com/Pa-St/Patient-Confidentiality.html
[4] Gupta, Y. (02, July, 2020). Mr. X vs. Hospital Z. Indian Legal Solutions. indianlegalsolution.com/mr-x-vs-hospital-z/.
[5] Chaturvedi, S., Srinivas, K., & Muthuswamy, V. (2016). Biobanking and Privacy in India. Journal of Law, Medicine & Ethics, 44(1), 45-57. 10.1177/1073110516644198