Professional secrets

Image source: Nano Banana

I read the Hive Learners post today and immediately had to think of how to approach it. They were asking about how doctors, lawyers, and priests have a code of confidentiality. As a Pharmacist I can directly speak about Medical confidentiality where I live and know that it is very different than the confidentiality of a lawyer because I have some lawyer friends. As for the confidentiality of a priest. Well, I don't know any priests so I can't comment on that.

How are they different?

As a Pharmacist I am required to keep patient information confidential. If you have a disease condition I'm not going to share that with other people. If you are on birth control, use viagra or even just use prescription multivitamins I keep that confidential.

I still have a duty of care to the patient though. If a medical provider calls needing your medication list to provide care I am obliged to help them in providing care. I'm also obliged to take reasonable precautions to ensure that they are indeed providing care and not just fishing for information.

I have a duty to the community. If I receive information which puts the professional conduct of another health professional into question I am legally responsible to report if I believe they are a danger to the public.

I have a duty to protect those who can't protect themselves. If I see an incapacitated elderly person, a child, or other vulnerable person who is being abused I have a duty to report it.

I have a duty to prevent imminent harm. If I know someone is intending to use their medication to commit suicide, commit murder, or in another way harm another individual then I have a duty to report it.

So when the Hive Learners asks should a professional disclose information if it will save lives my thought is "I'm actually legally obligated to do that already".

But there are gray areas.

There have been a couple of things I have heard in the Pharmacy that really bothered me. I'll let you decide for yourself if you report or don't report.

Scenario #1:

A person is a carrier of HIV. Of course I would keep that information confidential as there is a stigma associated with the virus/disease. I have no issue with that. However, when they broke up with their long term partner they started dating a lot of other people and admitted that they (a) never disclosed they had the virus and (b) hated to use protection so they only had unprotected sex.

What should I do with that information?

Scenario #2:

A person picks up a large quantity of Viagra. No problems with confidentiality there as some people need to use it and some people have a vigorous sexual life. Plus there is a stigma with impotence. I'm not saying anything. Then when we are discussing the prescription they tell me that they enjoy slipping it into their partners food without them knowing.

Now I know they are abusing their medication causing a potential risk to others.

And no, I'm not telling my decision, I'm just presenting it as times when my desire to keep things confidential and my interpretation of the laws was challenged. (and yes I had to do some research to decide my professional obligation in both cases).

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People want confidentiality but only when convenient

There is also the other side to confidentiality. When people want me to release their information to make their life easier but in a way that I'm not allowed to do.

On the one hand I fully understand that giving out the information they requested will be unlikely to be a problem most of the time but there are instances where it could be a serious breach of privacy.

Scenario #1

I regularly get people calling in to get some information from their medication profile. A simple request "I'm at the dentist and they need my care card number".

Scenario #2

How about a phone request "My husband has asked me to refill all of his prescriptions for him. Can you get them ready to go?

Scenario #3

A phone call comes in saying "I'm preparing the taxes for my husband and myself. Can I get an expense report for last years taxes"

Scenario #4

A phone call saying "Can I get a refill of my daughters birth control pill"

What do you think? Harmless?

All of those seem like simple requests but let me ask you this:

• How do I know the person asking for the care card number is really them? If I give out a care card number to the wrong person I'm giving information that can be used for identity theft.

• How do I know that the spouse is still married and that they have disclosed all the medication they are taking. If I just fill all the medications with refills and one of them is Viagra... and the wife hasn't had sex with the husband for a long time... how much trouble did I get the husband in? Another case I heard of was a wife asking for her husbands medication for a psychiatric condition (Lithium). The problem was that the wife was suing for divorce and using the husbands mental health as a weapon against him for child custody.

• For the tax returns? Same problem as above. I have no issues giving a complete list of medications for a year to the individual so they can file their taxes but their spouses information is confidential (without a power of attorney).

• The birth control pill? That's a tough one. The daughter is under the parents care (well, assuming they are not an adult yet) but some daughters don't want their parents to know they are using birth control.

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All of the requests seem very simple until you look a little deeper

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Lawyers have different rules

My confidentiality is one thing. Strictly regulated but with exceptions. Lawyers are strictly regulated with even fewer exceptions. I can only speak to their rules by hearsay from friends. However they have told me that they need to get more information that can absolutely be them admitting to committing a crime. The thing is that they need ALL the information so they can give the best advice and make the best defense. Now some people will say "Why would you bother protecting a criminal" . However, its not about protecting the criminal as much as it is getting them a fair verdict.

A crime may carry a 5 year sentence or a 25 year sentence depending on the circumstances. A lawyer needs to know all the details, even the criminal ones, so they can present the best argument for a lighter sentence. In that regard the lawyer need to know all the details, even the sordid ones, to present a coherent defense for their client. I don't believe criminals should avoid justice but I do believe that a criminal should be judged fairly and be defended by someone who knows the law.

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As a side note I can say that "knowing the rules" is very important because ignorance can lead to unintended consequences. In my own case it is about dealing with WorkSafe. Worksafe is an employee protection agency where I live. If someone is injured at work they work to get people income, training, and support. In my case my fingertips react badly to the prescription labels at work. Indeed, during COVID when I worked a lot of hours, pretty much all the skin came off my fingertips. It was awful.

But here is the problem. Worksafe asked : "How many shifts did you miss at work" and I honestly replied None. I worked all my scheduled shifts. However, because I have a flexible schedule with my employer I got fewer shifts than usual because my fingers were in bad shape. I was asked that question by a number of case managers and I always answered truthfully. None. After a few years a case manger asked a different question "Have you lost wages because of your condition" and I truthfully answered "Yes, I make about half as much as I used to". Now, if I answered that from the beginning there was a potential for wage loss benefits but because I misunderstood the question? Things went very differently for me.

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Now lets look back at a criminal at trial. Let's assume that they are guilty and tell the lawyer of their guilt. Why should the lawyer defend them? So that the person who doesn't know the rules doesn't make a mistake that can cost them dearly. If I had someone doing my Worksafe case I could have answered the question they meant rather than the question I heard. That simple difference could have made a difference for me and can absolutely make a huge difference for someone in a courtroom.

But even lawyers have a responsibility to disclose information.

The exceptions may be much more restricted but I'm almost certain that if a criminal admits that they locked a kidnapped person in their basement in a place the police will never find? I bet the lawyer has a duty to tell the police to prevent imminent injury to the person who was kidnapped. If a criminal admits that they planted a bomb to go off and injure hundreds? I'll bet the lawyer has a duty to report to prevent the loss of life.

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Keeping a secret

To finish things off for the Hive Learner prompt?

I absolutely take confidentiality very seriously. When given sensitive information there is a duty to keep things secret to protect the individual. The knowledge that the professional will keep your secret is vital to make sure the person feels open enough to talk so that the best outcome can be reached.

That is the reason we have confidentiality laws: So someone feels safe enough with their Doctor, Lawyer, Priest or even Pharmacist so that those professionals can help their client/patient the best they can.

.... But there are limitations and exceptions

.... And I'm very glad there are.

There are some secrets that I don't want to keep. If I ever had to keep a secret and know someone died because I kept silent--that would weigh very heavily on me.

... and that's my take on today's Hive Learner post. As always I love getting comments and also thank you for reading this far. Eyes on my posts are always appreciated. Thank you.