# Patient confidentiality: a problem or a solution?
Canonical source: [https://www.braver.net/en/blog/patient-confidentiality-a-problem-or-a-solution/]()
The Braver journal
When it comes to health innovation, we quickly get caught up in the various laws set up to safeguard the public. For some, these laws are an unreasonable impediment to innovation, while others see them as an important ethical requirement.
![Marie-Lou Gagnon]()
Marie-Lou Gagnon December 12, 2019
![Patient confidentiality: a problem or a solution?]()
Patient record confidentiality, professional secrecy, security of health data: laws on the protection of personal health information are complex. In Canada, the Personal Health Information Protection Act (PHIPA) passed by the Ontario government in 2004 deals with the protection of personal health information and has two main areas of action:
- Patient consent to the disclosure of confidential information; and
- Adequate security measures to prevent leaks of personal data
This act, as well as the equivalent regulations on the Quebec side, has a major impact on many players in the healthcare system, including professional associations, healthcare professionals, healthcare institutions, the work tools used in healthcare and, of course, the patients themselves. In Quebec, we can definitely say that our health system is in great need of innovation. And while the integration of these new technologies offers many opportunities to facilitate everyone's work and improve care, there are also major risks that emerge with regard to the confidentiality of data.
From a technical point of view, in terms of the security of the storage and transmission of health data, although there are many challenges, it is possible to comply with Canadian standards and develop a highly secure technological infrastructure. The development of these security measures requires good technical skills, but is feasible with the right tools.
From a human point of view, however, confidentiality is instead ensured by professional secrecy and the patient's consent to disclose this protected information.
"Professional secrecy is the duty of a professional not to share confidential information that a client has entrusted to him or her". ([source]()) In other words, any professional practicing in Québec has an obligation to comply with its code of ethics and thus to respect the confidentiality of the confidential information entrusted to him or her. The laws surrounding these concepts were created to protect the patient and the relationship of trust established between the patient and the professional.
As professionals, we care about our patients and we try to collaborate with other professionals to provide the best possible care. However, since we are bound by "professional secrecy, which is a right for the one who makes the confidence and an obligation for the one who receives it," the patient must give us his free and informed consent, which allows us to breach this professional secrecy. ([source]()) And this consent is limited in scope. In other words, it is restricted to a specific act for a period of time that is deemed appropriate.
Let's take the example of Maria, a 16-year-old girl, who is consulting a physiotherapist in a private clinic for her ankle pain. Maria has been having a difficult time at home and at school of late. The condition is not progressing very well and the physiotherapist wonders if Maria is experiencing a stress fracture. She asks for Maria's consent to write to her family doctor to explain the progression of her ankle and to suggest a medical imaging exam. A few weeks later, Maria is still undergoing physiotherapy and is developing a good relationship of trust with her physiotherapist. She began to confide in her physiotherapist and told him that she had stopped going to school since she had just discovered that she was 3 months pregnant. For the moment, her parents are not aware of it and she hasn't told anyone else.
Does her physiotherapist have the right to tell her family doctor since Maria has already given her consent to share information with him?
According to the law, the answer is no, since the consent given was in relation to the adverse changes in her ankle related to the possible presence of a stress fracture. The physiotherapist would like to help her patient and her desire to share this information with the family doctor is admirable: she wants to provide the best possible care for her patient. However, Maria must give her physiotherapist consent to share this new information with her family doctor or she must visit her family doctor herself.
The law on consent was introduced to ensure the protection of the patient and should be used to remind the healthcare professionals that all information given to them by the patient belongs to the patient. Our society is changing very rapidly and we are entering an era of the "patient revolution". The patient wants to be at the center of his or her care and become the master of his or her health. This revolution is very much in line with the efforts made over the last 15 years to make the patient more and more responsible.
Over the last few years, patient consent has taken the form of a signature that is carefully preserved in the patient's file. In other words, it is as if we were the guardians of this consent. As if the patient handed it over without really knowing if it would ever be returned to him or her.
As of 2019, technology now makes it possible to hold the patient's consent in our hands at all times. It is now possible to picture a world where the patient is the first viewer of his or her health. A world where the patient can give consent in real time from his or her cell phone while sitting in his or her living room. He or she thus assumes the role of guardian of his or her own health and becomes the central person at the center of his or her healthcare team. We must not be surprised by this revolution of the patient, after all, isn't that what we have longed for?