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BREACH OF CONFIDENTIALITY: UNINTENTIONAL COMMON PRACTICE DUE TO MISUNDERSTANDING AND 

UNAWARENESS  

 

Mohammad Waseem Khan 

Master Student of Bioethics, Aga Khan University Hospital, Karachi, Sindh, Pakistan. 

Email: mwaseem.tareen@yahoo.com 

 

Abstract:  Advancement in medical technology has helped man kind in several ways and no one can deny the 

contribution of medical technology in the field of medicine. On the other hand technology has also given rise to some 

ethical issues. The issue of confidentiality is one of those issues. Patients keeping their trust on physician reveals all 

concerned confidential information to their physician with surety that physician will not reveal it to other person and 

will keep it confidential. It has been common in practice that, physicians unintentionally breach their patient’s 

confidentiality by discussing cases and history of their patients in public places, hospital elevators, and with their 

students. In a busy hospital setting it can be difficult to maintain confidentiality for patients. Increasing workloads lead 

to discussions of patients in public areas which is not an acceptable excuse. The very next person present there 

listening the discussion could be a patient's friend, relative, or media member that is not entitled to this privileged 

information. In all these cases permission must be received from the patient prior to any disclosure.  

Introduction: The principal of confidentiality involves sharing of information with the expectation that it will not be 
revealed to third parties, or that it will be revealed under restricted circumstances with consent of the owner. The 
principal of confidentiality is usually applied to private information of the patient which is an important aspect of 
privacy between patient-physician relationships. Health care professionals have a legal and ethical duty to keep 
patient’s medical information private. Physicians and nurses, along with hospital staff are required by law and 
professional codes to practice confidentiality.

1
 

Patients have right to expect that information about them will be held confidential in confidence by their doctors that is 
central to trust between doctors and patients. In our environment we see many tertiary care hospitals following the 
policy of confidentiality but still unable to follow it in practicality. There are number of cases in which patient’s 
confidential information are shared in hospitals and public places by the physicians and the healthcare team. 

The duty of physician includes the confidentiality of their patients which need physician not to disclose any medical 
information which is discovered by physician or revealed by patient to physician. The obligation of confidentiality can 
be breached in specific situation where benefit gain is greater than breach of confidentiality. Situations where 
confidentiality can be breached include public welfare and concern for the safety of other specific person. As far as 
the case which includes the breach of confidentiality for education and teaching purpose, care needs to be taken by 
avoiding common practice mentioning patient names. Patient’s confidentiality can be maintained by not disclosing 
patient name and allotting identification numbers to patients and discussing each case by their identification number. 
Identification number will help maintaining patient confidentiality and achieving desired purpose of education to the 
medical students.  

Case Study: In a tertiary care hospital (Quetta) a patient (X) after visiting his physician (D) came to know that his 
physician has breached his confidential information to the people while discussing the case with medical students for 
teaching purpose in consulting clinics. In consulting clinics there were some other patients with their relatives waiting 
for their meeting with the physician. The patient was told by one of his family member (F) who was present in 
consulting clinic's waiting area as the physician was pointing him out with his name. The information revealed was 
meant to be confidential which the patient was unwilling to share with anybody else other than his physician. 

Ethical Issue: Maintaining patient confidentiality is one of the most important columns in clinical practice. Physicians 
and health care providers have the duty of protecting the private details of their patient. Maintaining patient 
confidentiality is not just a matter of moral respect but is an essential element in retaining the important bond of trust 
between the physician and patients. Physicians are bound to obey and are governed by the rules of confidentiality. 
Physicians and health care providers can not reveal a patient's medical history, even to their closest family members 
or friends, without the permission of their patient. 



Bangladesh Journal of Bioethics 2011; 2(3):16-18 

 

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Analysis In Norman Daniels Framework: Now,  I  will  try  to  unfold  and asses the  above  case  by  following  
Accountability for reasonableness approach  presented  by Norman Daniel which is mainly based on justice and fair 
selection. Four main postulates of AFR include: 
 

1. Publicity   

2. Relevance   

3. Appeals and revisions  

4. Regulative (enforcement)   

Publicity condition: As it is claimed by Norman Daniels that accountability for reasonableness makes decisions in 
healthcare legitimate and fair. The first condition of priority setting states that decisions and their rationales must be 
accessible to public. Applying accountability for reasonableness we see that in cases of protecting patient’s 
confidentiality the hospitals has clear cut policy of applying the principal that follows the first condition of 
accountability for reasonableness and the policy is sometimes accessible and understand able to the public and 
some time it is not. It may be made easily accessible to the public by creating awareness programs to the public.

2, 3, 

and 4 

Relevance condition: Applying the second condition of A for R in priority setting which states that rationales for 
priority setting and decisions making must rest on valid reasons. The patient’s confidentiality is sometimes overruled 
by health care professionals which might not always be legal. Firstly it should be done with the permission of 
concerned patient and should be justified with greater ratio of benefits to risks. The relevant condition needs to be 
explained with reasonable explanation by health care provider to the patient whether that is to be discussed with 
another physician, family members or to the students for teaching purpose. 2, 3, 4 

Appeals and revisions condition: Moving to the third condition of A for R, appeals and revisions should be 
welcomed by the organization in any case where the affected body thinks that the breach of confidentiality is not 
justified or if he shows any concern. For any process, appeals and revisions plays a pivotal role for future betterment 
of decision making. There must be mechanisms for challenge and dispute resolution regarding limit-setting decisions.

 

2, 3, 4
 

Regulative condition: As for as the fourth condition of A for R is concerned a lot of mishaps occur there. Health care 
organizations do make the policies to follow the principal of confidentiality and to safeguard their patients, but it is not 
ensured that they are applying that policy in their day to day practice. In many cases it has been seen that health care 
professionals some way the other do breach their patient’s confidentiality without knowing themselves. In many cases 
the confidential information has been discussed widely in public areas of the health care hospitals by the health care 
professionals and the team working in health care hospitals.

 2, 3, 4
 

 

Observational studies in tertiary care hospitals have shown that breaches of Patient’s confidentiality by healthcare 
professionals occurred by discussing patients by name at parties or even in hospital elevators or cafeterias. Most 
healthcare professionals know the limits of confidentiality well but they have trouble applying them to their behavior 
as they are unintentionally involved in breaching their patient’s confidentiality.

5, 6
 

Beside the conditions of accountability for reasonableness for any action to be reasonable it must pass through 
relevant phases of responsibility, authority and accountability. As in cases of confidentiality the physicians are 
responsible for their patient confidentiality and if they are given the suitable environment and authority to accomplish 
their job then they should be accountable for the protection of their patient’s confidentiality. 

Conclusion: Maintaining confidentiality is increasingly difficult in modern medicine as many people have access to 
medical records, including the attending physician, house staff, medical students, consultants, nurses, social workers, 
pharmacists, billing staff and medical records but all possible measures should be taken to safe guard patient’s 
confidential information to maintain the value of trust between patient and physician. As confidentiality is not only 
between the individual and the advisor but it is also between the individual and the organization for this reason a clear 
cut policy should be made by health care organization following the four conditions of accountability for 
reasonableness which will be helpful in avoiding breach of confidentiality and will ensure that decisions are made 
fairly. 



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5. 
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