Covid-19 Pandemic and Confidentiality of the Patient in Health Care Facilities

The “Universal Declaration of Human Rights (1948)” recognizes privacy, dignity, fairness, and inalienability for all people. It is on this idea of fundamental human rights that the concept of patients’ rights is formed. This is referred to as “Rights to Confidentiality,” which implies that personal data shared with a physician, an attorney, therapists, or any other individual cannot be exposed to a third party without the consent of the patient/client (Menger, Storey, M., Guthikonda, Missios, Nanda, & Cooper, 2015). However, the peculiarity of the coronavirus (Covid-19) pandemic has generated scenarios that appear to test this long-held medical principle. The governments worldwide were sometimes forced to defend their testing procedures and records in public, which requires disclosure of medical information of the patients who made accusations against the authorities. Simultaneously, in some instances, private data of expected infected individuals are revealed to protect the public. This article explores patient confidentiality during the covid-19 pandemic and implementing best practices to ensure that the patient’s medical data is kept safe and private.

Patients’ Right to Confidentiality

Patients have the right to the confidentiality of personal medical information. Medical confidentially means that a medical professional upholds the patient(s)’ medical record/information and keeps it private and safe from the third party. This restricts access to the healthcare provider’s classifiable medical records, which should be kept confidential and private, and not indulge in other organizations without the client’s consent (Canadian Nurses Association 2017). The entrenchment of medical professionals’ duty of confidentiality is anchored on the constitutional right to privacy under federal regulations on privacy, confidentiality, and healthcare security. “Health Insurance Portability and Accountability Act, Privacy Rule (2000)” for instance, establishes particular individual rights in medical information, imposes limitations on use and disclosures of classified patient data, and provides for criminal penalties for violations (Gunn et al. 2004).

The “Privacy Act of 1974, 5 U.S.C. – 552a” establishes a “code of fair information practices.” The Act governs the gathering, maintenance, usage, and diffusion of classifiable data about people preserved in federal agencies’ systems of records/information. It prevents federal agencies from revealing any information enclosed in the system without express consent from individuals whose data is contained in the system. Besides, medical professionals are also sworn to their clients’ confidentiality and must get written consent from the client to disclose health records to any third-party, even for treatment purposes (Menger, Storey, Guthikonda, Missios, Nanda, & Cooper 2015). The confidentiality laws essentially aim to protect information linked to health conditions regarded as “sensitive” by most people, translating to stigmatization.

Patient’s Confidentiality in Times of Covid-19

The peculiarity of the novel coronavirus (Covid-19) pandemic has generated scenarios that appear to test this long-held medical principle. Cases have been reported where patients complained of wrongful diagnosis, some patients infected with Covid-19 virus escaping from the isolation centres, and likely to infect others while others fail to give accurate records to the authorities as per the regulations. The circumstance prompted the authorities to publicly avail names of infected individuals who escaped from isolation centres. The agencies were also prompted to defend their testing procedure and records in public, which sometimes call for disclosure of personal medical information of the patients that complained against government agencies and in some cases, private records of infected individuals are made public to protect other people (Ananth, 2020)., raising the question of a potential violation of the patient’s confidentiality rights.

The Covid-19 pandemic presents a new challenge to governments worldwide in balancing the responsibility to contain the pandemic and the citizens’ fundamental rights, including the right to confidentiality and privacy of private data. As the governments in many parts of the world grappled to tracking and tracing of confirmed and suspected Covid-19 cases using personal information, it raises concern whether the measures invaded the citizens, right to confidentiality and privacy. There is apprehension about confidentiality issues with the application of tracking apps (Ananth, 2020). The contact tracing and tracking measures taken by different states have been criticized as a direct violation of patients’ right to confidentiality and privacy, and medical ethics.

However, the fact that government agencies employ such strategies for the national interest, and public welfare overrides the individual concerns for confidentiality and privacy. At common law, patent-doctor confidentiality and right to privacy are protected. Confidentially in health systems are considered in law as privileged communication between patients and doctors, nurses, and other clinical personnel. They expect confidential communication in the relationships (Shekhawat, Meshram, Kanchan, & Misra, 2020). However, in some jurisdictions such as South African doctor-patient confidentiality may be breached when there is a social, legal, or moral obligation disclose to an agency or individual that has a joint legal, social or moral responsibility to consume the information such as the court or where it poses a danger to the third-party such as the general public. It can also be breached when the patient sued the doctor to the regulatory authority, and the doctor needs to disclose some information as part of the defense. In such cases, the doctor must inform the patient that common law or certain statutes oblige them to breach the confidentiality rules, especially in the public’s interest or for third parties (McQuoid-Mason, 2020). The novel coronavirus is an example of a constitutional responsibility to report notifiable infections or diseases to the selected health authority/government agencies where the disease poses a serious risk to the broader public.

Either way, there is always the need to ensure that the interest of patients, friends, and the community is protected and that they do not experience social discrimination or stigmatization because of the disclosure (Canadian Nurses Association 2017). However, The Covid-19 pandemic has raised some legal and ethical issues concerning doctor-patient relationships, particularly the doctor-patient confidentiality, as there was circumstantial proof of stigmatization of infected persons in many government jurisdictions globally the onset of the pandemic. Rothstein (2015), for instance, maintains that protecting the privacy of patient’s information during health research is essential because health studies encompass the collection, storage, and usage of a substantial amount of personally classified health data, which might be sensitive and even embarrassing. Breach of privacy may expose the affected person to several potential harms, including stigmatization because others know that confidential information is known. There is also the economic harm, where the affected persons could lose the job, housing, or health insurance if a wrong type of information is made public. The patient may also suffer from identity theft in the process (Rothstein, 2015). This explains why confidential information about Covid-19 must be treated as confidential and care taken to avoid psychological harm to the patients.

1. Comparison with What Is Observed At Placement

Physician or nurse-patient confidentiality is a pertinent and essential issue in my placement organization, Perth and Smith Falls District Hospital (PSFDH). As volunteers, the first instruction during the induction was that nurses and physicians should record or use only the patients’ information necessary and access only the records needed. The nurse should ensure that the patients’ information and records, either physical or electronic, are secure and confidential. For example, we are encouraged to keep our desk tidy and take extreme caution never to be overhead when discussing patients’ issues/cases and never to talk about patients’ cases in public. All the interns are introduced to the organization’s code of ethics, written policies, and procedures on nurse-patient confidentiality, which forms the privacy guideline throughout your organization’s practices.

• PSDH Written Policies And Procedures On Confidentiality

PSFDH policy guideline on confidentiality takes into the account federal and state guidelines. Individuals are required to respect confidentiality per the state’s relevant policies and legislations. PSFDH written policies and procedures require that all the volunteers sign a pledge of confidentiality and code of conduct during the orientation process. The document is placed in the volunteer file for reference purposes. It is expected that in the course of interaction with the patient, the patient may share personal or medical information. All the PSFDH care teams, including the volunteers, must hold in confidence the patient information that may be disclosed to protect the patient’s rights.

Implementation Plan for Physician/Nurse-Patient Confidentially Standards for PSFDH

	Steps for Knowledge to Action	Content Areas
Introduction: The purpose of this B.P.G. implementation plan is to achieve high standards of physician/nurse-patient confidentiality at Perth and Smith Falls District Hospital during and after the Covid-19 pandemic. It will guide the organization’s professionals to make informed decisions concerning the confidentiality of the patients.
1.	Problem Identification, Review, and Selection of Knowledge	The nurse will be introduced to policies and regulations concerning patient confidentiality issues. A printed guidebook on a code of ethics will be provided to each staff to improve their knowledge about clients’ confidentiality management.
2 a.	Adapting knowledge to the local context	This step entails developing the necessary infrastructure for implementing the B.P.G. Organization code of ethics, particularly concerning confidentiality and privacy, and will be critically appraised and adapted where necessary.
2 b.	Stakeholder analysis	The stakeholder will be identified and engaged in leading physician/nurse-patient confidentiality standards and policy programs. Stakeholder, in this case, includes physicians, nurses, and hospital management.
2 c.	Assessment of resources	The resources will be assessed using the readiness worksheet to identify resources needed to implement best practices for patient confidentiality and privacy. Such include training programs and facilities.
3.	Assessment of programs facilitators and obstructions to knowledge use	This step entails evaluating the importance of facilitators for the program implementation and potential barriers to knowledge use. Strategies will be developed to ensure successful implementation.
4.	Selecting and tailoring intervention and implementation strategies	The implementation tools will be grouped according to training/learning, connection, feedback, patient-mediated, and hospital facility interventions
5.	Monitoring knowledge use and evaluating outcomes	Monitoring patients’ feedback/complaints on confidentiality and privacy issues. Adherence to the organization’s code of ethics and knowledge of application in different circumstances.
6.	Sustaining knowledge use	Developing an action plan guideline Performance appraisal Description and communication of positions, mission, vision, and values within the organization

            The uniqueness of the novel coronavirus (Covid-19) pandemic seems to shake the long-held medical principle of physician/nurse-patient confidentiality and information privacy. As such, government agencies and healthcare organizations are forced to re-engineer their privacy and confidentiality guideline to adapt to the pandemic. This essay has examined patient’s confidentiality in general and during the covid-19 pandemic and the implementation of best practice at my placement hospital, Perth and Smith Falls District Hospital (PSFDH), to ensure that the personal medical data of the patient is kept safe and private.

References

Ananth, V. (2020). Aarogya Setu’s not all that healthy for a person’s privacy’. The Economic Times.

Canadian Nurses Association (2017). Code of Ethics for Registered Nurses, 2017 Edition. Ottawa: Author.

Gunn, P. P., Fremont, A. M., Bottrell, M., Shugarman, L. R., Galegher, J., & Bikson, T. (2004). The health insurance portability and accountability Act privacy rule: a practical guide for researchers. Medical care, 321-327.

McQuoid-Mason, D. J. (2020). COVID-19 and patient-doctor confidentiality. SAMJ: South African Medical Journal, 110(6), 1-2.

Menger, R. P., Storey, C. M., Guthikonda, B., Missios, S., Nanda, A., & Cooper, J. M. (2015). Woodrow Wilson’s hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy. Neurosurgical Focus, 39(1), E6.

Rothstein, M. A. (2015). Ethical issues in big data health research: currents in contemporary bioethics. The Journal of Law, Medicine & Ethics, 43(2), 425-429.

Shekhawat, R. S., Meshram, V. P., Kanchan, T., & Misra, S. (2020). Privacy and patient confidentiality in times of Covid-19. Medico-Legal Journal, 0025817220935908.