Professional Secrecy

Disclosing Information to Third Persons: the Patient’s Family

Under review

CLINICAL CASE 
Mr. Paul G., 59 years old, who has just returned from a trip, is brought in by his brother and sister because of impaired cognitive function. The investigation leads to a diagnosis of AIDS and syphilis. The brother and sister ask for information and want to know what he has. Mr. Paul G. is a celibate priest and pastor of a parish. The patient expressly asks you to keep his illnesses a secret.
What do you do? 
 

The obligation to professional secrecy is established in favor of the patient. The patient may therefore authorize the physician to reveal confidential information concerning him. In these cases, the physician must provide the information in his possession which is pertinent to the request.

The Code of Ethics of Physicians (sec. 20) outlines the framework for establishing, not only ways to preserve professional secrecy, but the conditions to be respected in communicating information protected by it:

“A physician, in order to maintain professional secrecy […],
5° may not divulge facts or confidences which have come to his personal attention, except when the patient or the law authorizes him to do so, or when there are compelling and just grounds related to the health or safety of the patient or of others […]”

Sections 97 and 98 of the Code of Ethics also specify that,

“A physician must provide a  patient who requests it, or such a person designated by the latter, with all information allowing him to obtain a benefit to which he may be entitled.” (sec. 97)

“A physician must, at the patient’s written request and within no more than 30 days of its receipt, hand over to the physician, employer, establishment, insurer or any other persons designated by the patient, pertinent information from the patient’s medical record which is in his possession or safekeeping.” (sec. 98)

However, in everyday medical practice, the authorization to disclose information on diagnoses and treatments is not always clearly expressed. Often, persons who have helped the patient in the past, induced him to consult a physician, and who are likely to take care of the patient in the future, are progressively given information useful to the care and follow-up of the patient. For example, a patient may ask the physician to repeat to his daughter what has already been said to him. In this situation, there is an implicit and practical authorization to share information of a confidential nature with a third party. These “supportive” persons or  “natural helpers” rub shoulders with the medical team at various times during the care episode. In these circumstances, the physician must, in the interests of the patient’s well-being, consider himself or herself implicitly authorized to share information with loved ones and to enlist their cooperation in executing the treatment plan.

But the physician must be discerning and have a good understanding of the purpose of professional secrecy, which is to respect the integrity of the person, including his reputation. The physician must also respect the patient’s autonomy, for it is the patient who is most capable of judging the danger to his reputation vis-à-vis those who inquire about his condition. Each situation will present its own opportunity for physician and patient to assess the arguments for and against disclosure of the information to loved ones.

Professional support, spread out over several days, gave M. Paul G. time to examine the reasons why he was opposed to informing his relatives of his condition. Little by little, he came to understand that he greatly needed the help of his brother and sister to accept his prognosis. Touched by the physician’s unfailing commitment to respect his confidentiality, he himself disclosed the nature of his illness to his loved ones.