THE PATIENT’S PRIVACY AND MEDICAL CONFIDENTIALITY (AN OVERVIEW)

Question 1

What does patient privacy encompass?

Answer 1

personal space (physical privacy), * personal **data **(informational privacy), * personal choices, including cultural and religious affiliations (decisional privacy), and
* personal relationshipswith family members and other intimates (associational privacy).

Question 2

Patient informational privacy refers to the protection of personal information relating to a patient’s:

Answer 2

• health status,
• medical history,
• treatment, and
• other personal details obtained during the course of providing health care services.

Question 3

Meaning of confidentiality

Answer 3

The state of keeping or being kept secret or private

Question 4

Difference between confiential and anonymous

Answer 4

C- your info is known but kept private
A-Your identity is unknown

Question 5

Where do the ORIGINS OF THE PRINCIPLE OF RESPECT FOR THE PATIENT’S PRIVACY AND MEDICAL CONFIDENTIALITY erect from?

Answer 5

HIPPOCRATIC OATH (4TH CENTURY BC)

Question 6

Who was Hippocrates?

Answer 6

Known as the “Father of medicine”

Question 7

What was Hippocrates?

Answer 7

He was a very famous healer [physician], teacher of medicine and author in the ancient Greek world.

Question 8

Hippocrates method

Answer 8

• Heseparated medicine from magic by no longer accepting that the gods are responsible for all disease.
• Hippocrates allowed observation, rationality and respect for his patients to guide his practice

Question 9

What did he use scientific method for?

Answer 9

he carefully recorded his patient’s symptoms and responses to treatments, and used the data gathered to evaluate and prescribe the most successful treatments.

Question 10

Who was Apollo

Answer 10

Apollo, the son of Zeus [king of the gods], was the Greek god of healing, truth and prophesy.
Hewasthefather ofAsclepius

Question 11

Who was Asclepius?

Answer 11

Asclepius was the god of medicine and healing

Question 12

Who was Hygieia?

Answer 12

Hygieia was the goddess of health, sanitation and cleanliness (hygiene). * Shewas the daughter ofAsclepius. * Hygieia’s animal was a serpent.

Question 13

Who was Panacea?

Answer 13

• Panacea was the goddess of universal health or remedy/cures in the form of medicines, salves, etc.
• She was the daughter of Asclepius and sister of Hygieia.

Question 14

What did Hippocrates and his school contribute to?

Answer 14

a great deal to the study of contraception and abortion

Question 15

What was used as contraceptions in ancient Greece ad what was the effect?

Answer 15

vaginal pessaries embedded with medications (ie, herbs, pomegranate, crocodile dung) were used as contraception; however, it has also been documented that they caused intense local inflammation and injury to women.

Question 16

What did the most usual methods of abortion include?

Answer 16

• herbs to stimulate uterine contractions (pennyroyal, tansy, artemisia)
• purging substances (herb emetics, enemas)
• physical methods (abdominal pressure or massage, carrying heavy loads, jumping, hopping)
• dietary restrictions
• magical and superstitious practices, and the insertion of vaginal objects.

Question 17

What wpuld be the effect if pessaries were used for abortions?

Answer 17

this would carry more risks than most of the aforementioned methods; it would be wise to avoid prescribing this method of abortion.

Question 18

What was The Father of Medicine’s(Hippocrate’s) impact on Urology?

Answer 18

He predicted the necessity for specialized physicians with certain surgical abilities and broad medical knowledge, establishing in some way the specialty of Urology.

Today’s urologists can still learn from the prognostic thoughts, the ethical principles, the philosophic concepts and the humane messages of Hippocrates.

Question 19

Through which legislative provosions was the EVOLUTION OF THE PRINCIPLE OF RESPECT FOR THE PATIENT’S PRIVACY AND MEDICAL CONFIDENTIALITY illustrated?

Answer 19

• WMA ‘THE PHYSICIAN’S PLEDGE’ DECLARATION OF GENEVA (1948)
• SAMA DOCTOR’S PLEDGE 2020

Question 20

HPCSA on confidentiality

Answer 20

It views confidentiality as central to the doctor–patient relationship and a core aspect of the trust that holds the relationship together

Question 21

What acts as the HPCA’s official guidance

Answer 21

Confidentiality: Protecting and Providing Information (2021),

lists the key principles.

Question 22

Function of the HPCA guidelines

Answer 22

Health care practitioners must always be prepared to justify their decisions in accordance with these guidelines.

Question 23

What do the HPCA guidelines say about an instance where health care practitioners are asked to provide information about patients?

Answer 23

they should:
* seek the consent of patients to disclosure of information wherever possible, whether or not the patients can be identified from the disclosure;
* anonymise data where unidentifiable data will serve the purpose;
* keep disclosures to the minimum necessary.

Question 24

What are ICD-10 codes?

Answer 24

They are alphanumeric codes used by doctors, health insurance companies, and public health agencies across the world to represent diagnoses

Question 25

relation of patients to the ICD-10

Answer 25

Comprehensive information must be made available to patients with regard to the potential for a breach of confidentiality with ICD-10 coding (International Classification of Diseases, 10th version).

Question 26

Structure of the ICD code

Answer 26

Every disease, disorder, injury, infection, and symptom has its own ICD-10 code

Question 27

What are ICD-10 codes used for?

Answer 27

ICD-10 codes are used for, inter alia,:- processing health insurance claims;- tracking disease epidemics and- compiling worldwide mortality statistics

Question 28

What does Rule 13 of the Ethical Rules of the HPCSA state?

Answer 28

states that a practitioner may divulge information regarding a patient only

Question 29

Conditions to Rule 13 of the Ethical Rules of the HPCSA

Answer 29

only if this is done: * In terms of a **statutory provision**, * At the **instruction of a court**, * In the **public interest**, * With the **express consent of the patient**, * With the **written consent of a parent or guardian** of a minor under the age of 12 years, * In the case of a deceased patient, with the **written consent of the next of kin or the executor** of the deceased’s estate.

Question 30

Scope of disclosure in relation to public interest

Answer 30

Disclosures in the public interest would include but not be limited to situations where the patient or other persons would be prone to harm as a result of risk related contact.

Question 31

NATIONAL PATIENTS’ RIGHTS CHARTER say about confidentiality and privacy?

Answer 31

It states that info concerning one's treatment may onky be disclosed with informed consent except when required ito any law or any order of the court

Question 32

Common law protection of patietnt's personal info

Answer 32

The patient’s common law right to privacy requires health care practitioners to maintain the patient’s confidentiality.

Question 33

Actions that may be instituted by a patient against any practitioner who breaches their medical confidentiality

Answer 33

* invasion of privacy; * defamation; or * breach of contract arising from a breach of confidentiality

Question 34

Defences that may be raised by health care practitioners who who is a defendant in an action for breach of confidentiality

Answer 34

* the health care practitioner was compelled by a court order to make disclosure of the patient’s information * a statute requires the disclosure to be made;

Question 35

other defences that may be raised that may be raised by health care practitioners who who is a defendant in an action for breach of confidentiality

Answer 35

* the health care practitioner is under a **moral, social or legal obligation** to **disclose** information concerning their patient to a person or agency that has a **reciprocal moral, social or legal [right] to receive** the information * there is a **threat to an endangered third party** (‘the protective privilege ends where the public peril begins’)

Question 36

Instances that may limit the patient's common law right to confidentiality

Answer 36

* the patient lodges a complaint against a health care practitioner to their regulatory body (e.g. HPCSA) regarding their treatment and the health care practitioner is obliged to make certain disclosures as part of their defence. * the patient consents to the disclosure being made. * the patient is a public figure and it is in the public interest to make a public disclosure about their conduct when it is in conflict with their duties as a public official.

Question 37

Constitutional protection of the patient's info

Answer 37

* Thepatient’s right to privacy is guaranteed in section 14 of the SA Constitution. * A person’s right to privacy includes the right not to have ‘the privacy of their communications infringed’.

Question 38

General construction of the right to privacy

Answer 38

Generally, the right to privacy is construed as the ability to regulate and manage information about one’s personal life and relationships, free from unauthorised invasions and interference by the State and private persons

Question 39

How do patients often invoke the traditional articulation of the right to pricay in the health care system?

Answer 39

as a justification to limit who has access to highly personal and sensitive information (‘special personal information’) concerning their health status, as well as their treatment, decision-making and outcomes.

Question 40

How do patients often invoke the traditional articulation of the right to privacy with regard to the disclosure of health-related information to third parties,

Answer 40

To control the extent, manner and timing of any such disclosure.

Question 41

What is the National Health Act

Answer 41

It is the main/primary statute that deals with access to, and disclosure of, personal health information and related aspects.

Question 42

Purpose of chapter 2 of the NHA

Answer 42

codifies the rights and duties of health users (patients) and health care professionals.

Question 43

General outline of NHA

Answer 43

It has specific provisions that deal with confidentiality of patient health information, access to health records, and consent to disclosure of health information pertaining to patients.

Question 44

purpose of s14(1) of NHA

Answer 44

guarantees the confidentiality of all information concerning a patient.

Question 45

Conditions under which a patient's info may be disclosed ito s14(2)

Answer 45

information relating to a patient may only be disclosed if: * the patient provides written consent to the disclosure; * the disclosure is required by a court order * the disclosure is required by any law * or- non-disclosure would result in a serious threat to public health.

Question 46

Purpose f s15(1) of NHA

Answer 46

allows a health worker or any health care provider that has access to the health records of a user (patient) to disclose such personal information to any other person, health care provider or health establishment provided that: * the disclosure is necessary for any legitimate purpose within the ordinary course and scope of their duties and * such access or disclosure is in the interests of the user.

Question 47

S16(1)(a) of NHA

Answer 47

* a health care provider may examine a user’s (patient’s) health records for the purpose of the patient’s treatment. * However, the health care provider requires the user’s (patient’s) authorisation (permission/consent) to access and examine the health record.

Question 48

s16(1)(b) of NHA

Answer 48

a health care provider may examine a user’s (patient’s) health records for the purpose of **study, teaching or research**. However, the health care provider requires the authorisation of: * the user (patient); * the head of the health establishment concerned; and * the relevant health research ethics committee.

Question 49

What does section 16(2) of the NHA say in relation to s16(1)(b)?

Answer 49

if the study, teaching or research contemplated in section 16(1)(b) reflects or obtains no information as to the identity of the user (patient) concerned, it is not necessary to obtain the authorisations contemplated in that subsection

Question 50

What more does patient confodentiaity concern than simply refraining from disclosing the patient's info?

Answer 50

Persons in charge of health establishments are also responsible for ensuring that all records containing patient information are kept securely.

Question 51

What is POPIA and why was it enacted?

Answer 51

The Protection of Personal Information Act 4 of 2013 was enacted to protect personal information. POPIA is SA’s flagship data privacy legislation

Question 52

Purpose of POPIA

Answer 52

POPIA reaffirms existing legislative provisions of the National Health Act that deal with confidentiality and disclosure of health information, viz sections 14-17 of the NHA.

Question 53

Aim of POPIA

Answer 53

POPIA aims to, inter alia, regulate the disclosure of personal information ‘in a manner that gives effect to the right to privacy

Question 54

Purpose of POPIA according to its preamble

Answer 54

states that its purpose is to ‘regulate, in harmony with international standards, the processing of personal information by public and private bodies in a manner that gives effect to the right to privacy subject to justifiable limitations that are aimed at protecting other rights and important interests’.

Question 55

Def of processing

Answer 55

Any operation or activity or any set of operations whether or not by automatic means concerning personal info including: a)the collection, receipt, recording, organisation, collation, strage, updating or modification, retrieval or alteration, retrieval or use b)dissemination by means of transmission, distro or making available in any other form c)merging, linking, restriction, degradation, erasure or deswtruction of info

Question 56

Purpose of s26 of POPIA

Answer 56

generally prohibits the processing of special personal information.

Question 57

S1 read with s26 of POPIA

Answer 57

special personal information refers to, inter alia, the ‘health’ of a data subject’

Question 58

Legal Question in the Thabo Bester case

Answer 58

Can a health care professional who discloses confidential information shared by a patient during consultation/treatment be held liable for invasion of privacy or breach of contract arising from breach of medical confidentiality?