Changing practice on confidentiality: a cause for concern

Abstract

The dissemination of information about patients through computers and multidisciplinary teams involves departures from traditional tenets of confidentiality. This raises ethical problems, exemplified by current practices in child health. In multidisciplinary teams, problems may arise because different professions utilise different types of data. Some team members may not appreciate the extent to which data may be unscientific and judgmental. Children and thier families may be labelled, without justification, preventing objective reappraisal. The ethical and legal implications are considered. Practice may not conform to principles of natural justice, for example when care orders are sought. Obligations to the State may also imperil the confidentiality of the doctor-patient relationship, and of medical records, the legal status of which is confused and requires clarification. Allowing patients access to their records could be a useful safeguard, and the medical profession should devise alternatives should it not be accepted.

KIE: Misgivings have arisen in Great Britain concerning the trend, exemplified by current practices in child health care, toward computerization of health records and dissemination of patient information within multidisciplinary teams. Physicians, social workers, and teachers all generate qualitatively different data, ranging from the objectively scientific to the subjectively judgmental. Children and families may be incorrectly labelled and, without access to the child's records, unable to defend themselves in legal proceedings. Disclosure obligations and the confused legal status of medical records also imperil the confidentiality of the physician-patient relationship.