Self-Study Modules on Tuberculosis
Module 7: Confidentiality in Tuberculosis Control
The protection of private 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 the confidentiality issues that
are relevant to patient-health care worker encounters as well as
to the collection, management, and sharing of data gathered on TB
patients. Health care workers have a responsibility to protect patients'
confidentiality. However, health care workers may have to override
these rights in some cases, in the interest of protecting the public's
health. For example, patients with infectious TB disease may have
some rights curtailed until they are no longer infectious.
The patient-health care worker relationship relies on an agreement
to continue treatment until the patient's health problem is resolved.
Health care workers should respect the patient's autonomy, freely
provide complete and accurate information, and rigorously maintain
confidentiality. The patient-health care worker relationship is
the basis for sharing information, communicating beliefs and feelings
that affect care, and building trust in the value of the interaction.
The patient-health care worker relationship can be viewed as an
agreement between the patient and the health care worker. Basic
rules that each party will observe include respecting each other's
rights and upholding certain responsibilities. If either the health
care worker or the patient fails to conform to this agreement, the
relationship can break down and lead to misunderstandings, a lapse
in communication, or even treatment failure.
The term health care worker refers to any member of a team of health
professionals who care for and manage a TB patient, including physicians,
nurses, outreach workers, hospital discharge planners, pharmacists,
and social workers. A third party is a person or organization not
directly involved in the care of a patient's health problem. This
term includes anyone who does not play an integral part in the patient-health
care worker relationship.
Trust is the key to a successful patient-health care worker relationship
in which the rights and responsibilities of both patient and 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.
Patients have rights concerning their personal and private information
relevant to their medical care. These rights are summarized in the
|Type of Patient Right
|The right to give or withhold authorization of disclosures
|| The patient generally has the right to control who has
access to confidential information except as otherwise provided
by law. The patient needs to give specific authorization or
permission to allow a third party to have access to confidential
|The right to maintain privacy
|| Only those persons directly involved in the care of the
patient's health problem should have access to private information.
Health care workers should protect information revealed during
provider-health care worker encounters, including all written
or electronic records of these encounters.
|The right to have autonomy
|| Autonomy is the right of a patient to determine what will
be done with his or her body, personal belongings, and personal
information; this concept applies to any adult person who
is mentally competent. Sometimes the right to autonomy can
be overridden in the interest of protecting others who may
be harmed by the patient's decisions.
|The right to be given information
|| The patient has a right to information about his or her
medical diagnosis, treatment regimen, and progress. This allows
the patient to make appropriate, informed decisions about
his or her health care.
When interacting with patients, the health care workers should
always follow due process. Due process is an established course
for governmental activities or procedures designed to safeguard
the legal rights of the individual. The use of standard protocols
and forms can help ensure that important tasks (such as obtaining
informed consent or an authorization for release of information)
are not omitted. Documentation is also a crucial part of due process.
Confidentiality is an essential issue in several of the core components
of a TB control program. Health care workers are required to conduct
routine case reporting, which is reporting cases of suspected or
confirmed TB cases to a public health authority that collects and
analyzes the information. Because TB is considered a significant
threat to the public's health, the disclosure of patient information
is allowed for the purpose of TB control. Health departments are
required to protect the confidentiality of such case reports. If
a patient travels or moves, the health department of the patient's
home jurisdiction should notify the health department for the area
to which the patient moves. It is important that as much information
as possible is relayed to the receiving jurisdiction, within the
limitations of current laws and regulations governing the confidentiality
When a suspected or confirmed TB case has been identified, a treatment
plan is made for the patient and the patient's informed consent
is obtained. It should be made clear from the beginning of treatment
that confidentiality of the patient's personal information is an
important priority. Health care workers should discuss confidentiality
with the patient and determine who, if anyone, the patient wishes
to know about his or her care or to participate in decision-making.
When a contact or source investigation is to be conducted for a
reported TB case, a health care worker should interview the patient,
explaining the goals of the investigation, and why it is important
to know the names of contacts. The patient should be told about
his or her right to privacy and the measures that will be taken
to maintain confidentiality. Health care workers should conduct
contact investigations without jeopardizing the TB patient's confidentiality.
The patient should be assured that the contacts they name will not
be told who identified them as a contact. The health care worker
should be careful not to inadvertently reveal clues about the TB
patient (index case) during contact follow-up.
Testing for TB infection may be mandatory for specific groups of
people. Testing procedures should be designed and records maintained
in such a way that confidentiality is protected. It should not be
obvious to other residents or patients that a person is being evaluated
because of a positive skin-test reaction.
TB programs are responsible for collecting and analyzing data,
conducting overall planning and policy development, providing laboratory
and diagnostic services, and providing training and education. TB
control programs develop specific policies to ensure the security
and confidentiality of TB records and should train staff members
in procedures for maintaining and carrying out these policies. It
is particularly important to protect information on HIV serostatus:
in general, TB program staff should adhere to the same confidentiality
standards as HIV/AIDS surveillance programs and should work with
local HIV/AIDS programs to establish equivalent data confidentiality
Health care workers can provide measures to protect confidentiality
anywhere, whether in an office, clinic, institution, or in the field.
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