Dodek D Y, Dodek A
University of British Columbia, Vancouver.
CMAJ. 1997 Mar 15;156(6):847-52.
Although patient confidentiality has been a fundamental ethical principle since the Hippocratic Oath, it is under increasing threat. The main area of confidentiality is patient records. Physicians must be able to store and dispose of medical records securely. Patients should be asked whether some information should be kept out of the record or withheld if information is released. Patient identity should be kept secret during peer review of medical records. Provincial legislation outlines circumstances in which confidential information must be divulged. Because of the "team approach" to care, hospital records may be seen by many health care and administrative personnel. All hospital workers must respect confidentiality, especially when giving out information about patients by telephone or to the media. Research based on medical-record review also creates challenges for confidentiality. Electronic technology and communications are potential major sources of breaches of confidentiality. Computer records must be carefully protected from casual browsing or from unauthorized access. Fax machines and cordless and cellular telephones can allow unauthorized people to see or overhear confidential information. Confidentiality is also a concern in clinical settings, including physicians' offices and hospitals. Conversations among hospital personnel in elevators or public cafeterias can result in breaches of confidentiality. Patient confidentiality is a right that must be safeguarded by all health care personnel.
尽管自希波克拉底誓言以来，患者保密一直是一项基本的伦理原则，但它正面临越来越大的威胁。保密的主要领域是患者记录。医生必须能够安全地存储和处理医疗记录。应该询问患者某些信息是否应排除在记录之外，或者在信息被披露时是否应隐瞒。在对医疗记录进行同行评审期间，患者身份应保密。省级立法概述了必须披露机密信息的情况。由于采用“团队护理方式”，许多医疗保健和行政人员可能会查看医院记录。所有医院工作人员都必须尊重保密原则，尤其是在通过电话或向媒体提供患者信息时。基于病历审查的研究也给保密带来了挑战。电子技术和通信是保密违规的潜在主要来源。必须小心保护计算机记录，防止随意浏览或未经授权的访问。传真机、无绳电话和移动电话可能会让未经授权的人看到或听到机密信息。在临床环境中，包括医生办公室和医院，保密也是一个问题。医院工作人员在电梯或公共食堂的交谈可能会导致保密违规。患者保密是一项权利，必须由所有医疗保健人员加以维护。
