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Confidentiality is defined as making personal, identifiable medical information available only to the physician of record, health care providers and insurance personnel bound by confidentiality agreements and only as it is necessary to patient's care. A release should be signed by the patient allowing communication with insurance and billing departments. It is also recommended that providers have a patient sign a consent form allowing information to be shared with adjunct care providers as needed at the provider's discretion. A release may also be signed for disclosure to parties in legal action. When a consent form is signed, confidentiality is not officially broken. Exceptions are made with regard to patient confidentiality to protect children and the elderly from abuse or to warn an individual when direct and convincing threat has been made on their life. Law enforcement may be contacted, to prevent a patient from harming themselves. A minor's information is generally shared with their parent or legal guardian but minors may receive contraception, and have this kept confidential from their parent. There are states that require parental notification in cases of abortion, and others that require consent. Other information may be held as confidential such as thoughts or feelings shared in a therapeutic setting. Knowledge of ongoing criminal behavior dangerous to the health and safety of another may be reported to law enforcement. Any crime committed against the provider may be reported to law enforcement even if it involves revealing private information. Under emergency situations, when the patient is incapacitated, patient information may be discussed with next of kin and the patient's condition may be reported to the same individual, but only information necessary to the patient's immediate healthcare needs. The goal is to gather information from them not to reveal information like pre-existing conditions. A court order may override confidentiality laws in some situations. The information specified by the order must be provided to only those specified in the order, and information not specifically listed in the order remains confidential. Finally certain diseases are reportable to protect public health. This practice may expose the patient's name and the reportable diagnosis, but no unrelated medical or demographic information. Personally, I would agree with all of these exceptions, but I am conflicted on the abortion issue with minors. As a parent it disturbs me to consider my own child having a serious procedure like abortion, and then processing the trauma related to pregnancy and abortion without my knowledge or support. As a Nurse I concede this may be necessary to protect certain reproductive rights. I think the right of the courts to order disclosure and public health reporting should be loosely scrutinized and tightly controlled. I would take issue with an order to disclose my patient's information under certain circumstances.
It is possible for each healthcare professional to live up to their own responsibilities in protecting a patient's confidentiality. However, it is impossible for a professional to guarantee a patient absolute confidentiality, or for the system, as a whole to guarantee this standard. While each care provider can take responsibility for their own actions, the healthcare system, as a whole, is made up of people and people are fallible. Strict regulations and consistent, stringent sanctions can strongly discourage confidentiality breaches but won't entirely prevent careless error or egregious violations or influence providers who do not fully understand the concept. Identity theft and other technology related issues further place confidentiality at risk. Technology from phones to computers presents some level of vulnerability related to hacking, wiretapping, and phone/mail fraud. When communicating with insurance agencies or medical billing departments, it is impossible to be sure that no unnecessary personnel will access information or maintain their confidentiality responsibilities. As technology advances security is improved but not necessarily at the same rate allowing gaps in the protective walls.
Absolute confidentiality is an ideal, and strict confidentiality is possible but no system can provide absolute confidentiality. Every health care system relies on human beings and is therefore subject to human error. When appropriate exceptions are incorporated in the definition of confidentiality then confidentiality should never be violated.