A rock and a hard place? Ministry of Defence | Defence News | MOD confirms loss of recruitment data

[James Cox]

On 29 Jan 2008, at 10:32, Ian Batten wrote:

>
> On 28 Jan 08, at 2301, James Cox wrote:
>>
>> The medical code of confidentiality is extremely simple. Disclosure  
>> of patient data is illegal, period.
>
> As Roland points out, it's hard to see how insurance-based systems  
> (not just the US, but France and Germany) can operate in that  
> context.  Or how clinical audit can operate.  Or epidemiologists.   
> Or any sort of public health work.  Now `we' on this mailing list  
> will say that the anonymization of medical data isn't adequate, and  
> the confidentiality of identifiable data certainly isn't either, but  
> we're not saying that patient data can't be disclosed.  Because too  
> many children died in Bristol for that argument to work.

well, the insurance industries have codes of ethic and conduct about  
patient data- HIPPA being a prime example. The goal is for the  
insurance companies to be able to properly account and bill for  
procedures: they don't really have a good reason to know what the  
diagnosis is, etc. That is not true when it comes to auditing  
practice; for this insurance companies employ doctors who's job it is  
to review cases - doctors who will be also bound by ethics.

When it comes to wider clinical audit - practice management, hospital  
administration - even epidemiology... alot of this works well with  
anonymized data. Of course, our recent discoveries have shown that we  
cannot trust the government or her agencies to adhere to this. alas.

Referring to the case triggering this- that of anonymous v Surgi  
Center, NY- it's common for abortions to be off-insurance procedures.  
In this instance, the patient made a specific request which was  
ignored by the staff at the clinic, thereby violating the patient's  
privacy. The disclosure of the procedure happened because a clinic  
staffer called her home and spoke to the patient's mother - suitable  
layers of grey, to be sure :)

>
>> Except, of course, when you're dealing with a minor...
>
> Really?  Mrs Gillick will be pleased to hear that minors don't have  
> a right of confidentiality.
>
> It's all too complex to sit in ``extremely simple'' statements.   
> There's a lot of gr[ae]y.

The point was, if you have a procedure (especially an elective one),  
the hospital you go to isn't really permitted to inform a next of kin,  
unless you consent or are somehow incapable of making your own consent  
(e.g. being unconscious). Yes, it's complex and grey, but there are a  
handful of ethics that clarify behavior here..

-- james