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Module 7: Confidentiality in Tuberculosis Control
Reading Material

Introduction

Confidentiality

The protection of private patient information is commonly referred to as confidentiality. Confidentiality involves the protection of information revealed during patient-health care worker encounters, including all written or electronic records of these encounters. Confidentiality is an essential issue in many different aspects of TB control. Health care workers need to be aware of confidentiality issues that are relevant to patient-health care worker encounters, as well as to the collection, management, and sharing of information gathered on TB patients.

Health care workers should keep patient information in confidence and only divulge it with the permission of the patient except as otherwise required by law. It is the responsibility of the health care worker to protect the patient's private information and ensure that only those persons who need to know information have access to patient records. Only persons directly involved in patient care or public health activities should have access to patient information. Safeguarding patient information should be a priority for all members of the health care team.

Confidentiality is a very important issue in TB control because the diagnosis of TB disease is potentially damaging to patients. For some patients, a diagnosis of TB can lead to stigmatization or rejection by family, friends, and coworkers; the loss of a job; and possibly eviction from housing. There are some specific confidentiality issues that require special attention by health care workers working with TB patients:

  • The TB patient has certain rights that must be respected and are often protected by legislation
  • The health department has a responsibility to protect the public's health using certain effective TB control strategies
  • In the course of conducting TB control activities, some patient rights may be overridden in the interest of protecting the public's health (for example, an uncooperative, infectious patient may be quarantined until noninfectious)
  • Great care must be taken to ensure that patient rights -- especially the right to privacy -- are protected to the fullest extent possible so the patient-health care worker relationship is not compromised; this relationship must be strong enough to last throughout the time it takes a TB patient to complete therapy
     
Study Questions 7.1-7.2

7.1. What is confidentiality and why is it important in TB control?

7.2. List four specific confidentiality issues that require special attention by providers working with TB patients.

Answers 

The Patient-Health Care Worker Relationship

What is the Patient-Health Care Worker Relationship?

The patient-health care worker relationship is the basis for

  • Sharing information
  • Communicating beliefs and feelings that affect care
  • Building trust between the patient and health care worker

The quality of this relationship is important in determining whether medical treatment is successful -- particularly in TB control, where long-term adherence to a treatment regimen is critical. A strong patient-health care worker relationship built on trust and the preservation of patient confidentiality will increase the likelihood that the patient will be compliant and adhere to therapy.

The patient-health care worker relationship can be viewed as an agreement between the patient and the health care worker. On the basis of the diagnosis, the health care worker recommends a given course of action and both parties (the patient and the health care worker) agree to work together to resolve the patient's health problem. The agreement incorporates some basic rules that each party will observe during the course of the relationship; such rules include respecting each other's rights and upholding certain responsibilities to each other and to other parties (such as the general public or the patient's contacts). If either the health care worker or the patient fails to conform to this agreement, the relationship can break down. This may lead to misunderstandings, a lapse in communication, and treatment failure (see Module 9, Patient Adherence to Tuberculosis Treatment, for an example of an adherence agreement).

Who is Considered a Health Care Worker?

Health care worker refers to any member of a team of health professionals who care for and manage a TB patient, including

  • Physicians
  • Nurses
  • Outreach workers
  • Hospital discharge planners
  • Pharmacists
  • Social workers

For TB patients, the team of health care workers may include representatives from both the public and the private sectors. Because the health department has ultimate responsibility for the TB cases in its jurisdiction, the health department usually provides some oversight of the management of TB cases in the private sector.

Health care workers from the public sector who work with the private sector may find that health care workers from the private sector are reluctant to share patient information. Health care workers from the public sector must be prepared to inform health care workers from the private sector about health department confidentiality policies and procedures regarding the collection, management, and sharing of data gathered on TB patients.

Who is Considered a Third Party?

A third party is a person or an organization not directly involved in the care of a patient's health problem. Some third parties have legitimate reasons for becoming involved in the patient-health care worker relationship, such as

  • Providing financial reimbursements
  • Conducting research
  • Evaluating results of a program or intervention

However, this work is peripheral to the patient-health care worker interaction.

The difference between a health care worker and a third party is that health care workers have access to patient information and can share it among members of the health care worker team in order to care for the patient.

The only third parties who should have access to patient information are those whom the patient has specifically requested to be present during interviews or authorized to have access to records.

Developing Trust

Trust is the key to a successful patient-health care worker relationship in which the rights and responsibilities of both the patient and the health care worker are upheld. Trust implies a firm reliance by the patient on the integrity, ability, and character of a health care worker. If a patient trusts or has confidence in his or her health care worker, he or she is more likely to be willing and able to adhere to a regimen and follow the health care worker's instructions and advice. Health care workers should strive to be worthy of this confidence by earning the patient's trust. Three ways to earn a patient's trust include

  • Respecting the patient's autonomy, the right of a patient to determine what will be done with his or her body, belongings, and personal information
  • Freely providing complete and accurate information
  • Rigorously maintaining confidentiality

The Importance of Trust

By bringing his or her health problem to the attention of a health care worker, the patient is entrusting personal and private information to the health care worker. As the health care worker interviews the patient, the patient may divulge information about lifestyle choices and risky, even illegal behaviors, such as injection drug use. In addition, some patients may reveal that they reside in the United States illegally and fear being reported to immigration authorities. It is extremely important that the health care worker safeguard all patient information, including the patient's diagnosis, and assure the patient that this information will not be shared with authorities other than required by law.

If sensitive personal information is revealed to a third party without the patient's permission, the patient's trust of the health care worker could be threatened and may result in serious consequences:

  • The patient-health care worker relationship may be damaged, possibly affecting the care of the patient
  • The patient may be stigmatized or rejected by family, friends, and others
  • The patient may lose a job or be evicted from housing
  • The health care worker may lose the trust of other patients

 
Study Questions 7.3-7.7

7.3. What is the basis for the patient-health care worker relationship and why is it important in TB control?

7.4. How is the patient-health care worker relationship like an agreement, and what are some of the consequences if either party fails to conform to the agreement?

7.5. Who is considered a health care worker and who is the third party? What is the difference between the two?

7.6   Describe why trust is a key element in a successful patient-health care worker relationship and list three ways to develop trust.

7.7  What are some serious consequences of revealing sensitive personal information to a third party without the patient's permission?

Answers 


 
Case Study 7.1
Van is a cook at a local restaurant. He came to the health department after his girlfriend, Tanya, told him that she had been diagnosed with TB disease. After undergoing tests for TB, it was confirmed that Van also has TB disease. Van is not from the United States and does not have the proper documents to be working in this country. During the contact investigation interview, Van was reluctant to provide information on where he worked. He did not want to get his employer in trouble and he does not want to be reported to immigration authorities. Van was also afraid that if people at work found out that he had TB that he would lose his job. Finally, Van also admitted to injecting drugs with some friends once in awhile, but was reluctant to give their names because he didn't want his friends to know that he had TB. He was also afraid his friends might be reported to the police.
  • Why is it important to protect Van's confidentiality?
  • What can the health care worker do to develop trust with Van?

Answers 


 
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