Self-Study Modules on Tuberculosis
Module 7: Confidentiality in Tuberculosis Control
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.
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
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
- Outreach workers
- Hospital discharge planners
- 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
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.
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,
- 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?
|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