Professional Secrecy

Professional Secrecy’s Regulatory Framework

Under review

Section 20 of the Code of Ethics of Physicians cites the physician’s obligations with respect to professional secrecy.

20. A physician, in order to maintain professional secrecy,
 (1) must keep confidential the information obtained in the practice of his profession;
 (2) must refrain from holding or participating, including on social networks, in indiscreet conversations concerning a patient or the services rendered him or from revealing that a person has called upon his services;
 (3) must take reasonable means with respect to the persons with whom he works to maintain professional secrecy;
 (4) must not use information of a confidential nature to the prejudice of a patient;
 (5) may not divulge facts or confidences which have come to his personal attention, except when the patient authorizes the physician to do so or when the law authorizes or orders the physician to do so, or when there are compelling and just grounds related to the health or safety of the patient or of others;
 (6) may not reveal a serious or fatal prognosis to a patient's family if the patient forbids him from so doing.
 (7) must, when providing professional services to a couple or a family, preserve each member’s right to professional secrecy;
 (8) must take reasonable measures to preserve professional secrecy when the physician uses, or persons working with the physician use, information technologies; 
 (9) must record in the patient’s record any communication to a third party, with or without the patient’s consent, of information protected by professional secrecy.

In concrete terms, this means that:

  • waiting rooms and examination rooms must provide a discreet, welcoming and calm atmosphere that preserves the private nature of conversations between physician and patient;
  • the more sensitive the content of the conversation, the greater is the obligation to observe discretion;
  • protecting conversations of a private nature between physician and patient is also a concern for the administrators of health institutions, who must create practice settings conducive to confidentiality. Physician-administrators, like all other physicians, are subject to the Code of Ethics of Physicians of Québec;
  • the physician must avoid sources of distraction, for example, pagers or telephone calls during interviews, particularly when the situation requires attention and tact;
  • persons who collaborate with the physician (office employees and professionals) must respect the letter and spirit of professional secrecy;
  • the same reserve and discretion applies to the discussion of cases with colleagues or other professionals. In these circumstances, it is advisable to pay special attention to the place and manner in which the care of patients is discussed; this applies as well to teaching activities with students-in-training.

Finally, the obligations as regards professional secrecy also apply to the clinical research field. Even if the findings of all research projects must be disseminated, this must be done in a manner that preserves the anonymity of the subjects. Research ethics committees in institutions (including research centres in university hospital centres) must rigorously abide by these  rules. Like medical clinicians, medical researchers must take the necessary measures to ensure that their collaborators respect professional secrecy COLLÈGE DES MÉDECINS DU QUÉBEC,  Le médecin et la recherche clinique : guide d’exercice, Montreal, Collège des médecins du Québec, July 2007. Indeed, professional ethics concern all physicians and all activity sectors.