Confidentiality between patients and their doctors is one of the most essential pillars of medicine; ensuring that a patient’s private details are protected is not only respecting him, but also crucial in retaining the trust of the patient. A breach of confidentiality generally occurs when private information of the patient is disclosed without his consent.

According to the Singapore Medical Council (SMC) ethical code and guidelines, patients’ medical information in hospitals must be kept confidential. Except when required by law, it is against the hospital’s policy to share the medical information with those who are not involved in the patient’s care, unless they were given permission to do so. Additionally, hospitals may be required by public authorities to disclose information uncertain circumstances, an instance of this being notification of infectious diseases.

In this article, the exceptions of patient confidentiality in Singapore will be discussed in greater detail. Essentially, it is the obligation of the patient (or in some cases, of local public health officers) to inform the spouse and not the physician. There can be several types of circumstances, but there are two main ones where patient confidentiality will need to take a backseat:

1. When it is mandatory by law

A good example here is looking at a patient who has been screened to be positive for HIV. The patient has begged and pleaded that this information should not be disclosed to his wife. He has previously disclosed that he was sexually active with her. It is against the law for the patient to not disclose his positive HIV status to his partner in Singapore under the Infectious Diseases Act.

If upon further advice, he still insists that his wife not be informed, the doctor has the right to break doctor-patient confidentiality in this instance and inform the wife of the patients’ diagnosis.

2. Public health and safety

Physicians do have an ethical responsibility to society as well – they are given the duty to protect public health. Hence, there is an argument that a physician should not be allowed to breach confidentiality when public health or safety is threatened.

A good example is that of contagious disease cases. Reporting laws usually require disclosure of these diseases to the appropriate public health agencies. However, these statutes may also include provisions allowing for disclosure to specific at-risk individuals. This also means that disclosure may not be to only public health authorities and healthcare providers, but also to family members and even possibly needle sharers.

What about when the patient has been found to be using drugs and is being questioned by the police on the patients’ medical history? In such an instance the patients’ best interest may be that he seeks treatment and he is not necessarily harming anyone directly but it is simply the law that stands. The information is required to be given by law and doctor-patient confidentiality must be broken once again. Failure to give out the information in this case will mean that the doctor is breaking the law by not providing the required information and can be charged in Singapore.

Doctor-patient confidentiality is sacred and should not be taken lightly. Essentially, patients tell their doctors private information because they trust them. Hence, this confidence should be upheld always barring only when it is in the best interest of the patient or when it is mandated by law. It is important to remember that as a doctor, an oath has been taken “respect the secrets which are confided in me” - it is one’s duty as a doctor to see that it is upheld. MIMS

Read more:
Trusting medical professionals: The importance of respecting patient confidentiality
Supporting the patient’s choice to open access private to health information - yay or nay?
Are the revised SMC ethical codes and guidelines too vague?