Generally, the health practitioner owes the patient a duty of care to treat medical records with the strictest confidence. This necessary so as to elicit from the patient truthful and vital information very relevant to treating his ailment. Common sense suggests that unless the patient can be sure of this, he will not tell nurses or doctors all they may need to know about his condition because they may be aspects of the information he may not want to be made public. If confidence is abused deliberately or otherwise, the patient or his next-of-kin may complain to the hospital or the regulatory body concerned so that disciplinary action may be taken against the offender.
In situations such as the understated, the confidentiality rule, however, is subject to a number of limitations, both legal and moral:
I. Where the patient consents to disclosure e.g. where the purpose of examination is to establish fitness for life insurance.
II. Where it is undesirable on medical grounds to seek a patient’s consent as in case of mental incapacity.
III. Where the doctor has an overriding duty to the society.
IV. Where disclosure is justified in the interest of medical research.
V. Where the information is required by law.
As regards the right or duty to disclose information in response to society’s overriding demands, it seems clear that doctors and nurses must report whatever they may learn about a serious crime during the course of treatment.
Medical ethics demands that a physician may not reveal the confidence entrusted to him in the course of medical attendance unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or the community. Confidentiality is also affected by the interests of the patient’s relatives who are, of course, entitled to news of progress, but care must be taken so that the patient’s personal rights are not infringed upon. A vivid case that comes to mind is where a charge was brought against a doctor to the parents of a 16 year-old girl that she was on contraceptive pills. He was found not guilty of misconduct.
In the area of occupational health, a practitioner is under a duty to advise a patient about his fitness for work especially where the condition can only be found on medical examination. Disclosure cannot be made to a patient’s employer without his consent. If he refuses his consent, there is no alternative but to tell the employer he is unfit for work or for certain kinds of work but without giving reasons. Statements made in this context have qualified privileges. An employer may, if he wishes, obtain such consent in advance by making his right to see medical records a condition for employment.
The industrial doctor is in a strong position to suggest to the patient that he should disclose his condition since he may clearly be the one who will suffer if does not. Thus, in Cork v Kirby Maclean, 1952, a building worker who did not tell his employer that he suffered from epilepsy lost half of his compensation when he had a fit and fell from an insecurely guarded platform. Where, on the other hand, the patient suffers from disability which is not confidential but immediately obvious such as loss of a limb or an eye, then it is clearly the doctors or nurses duty to record this for the employer. A Nigerian case entitled “Abandoned blind worker cries for justice” involving one Tahiru Suleiman as reported in ThisDay of September 27, 2007 becomes apt and pathetic. This is because he claims to have been injured in the course of duty leading to total blindness. His employers, on the other hand, are claiming through their attorneys that Suleiman had impaired vision, a problem they reasoned he may have not disclosed in his records ab initio. This may have led to the unfortunate incident. But Tahiru Suleiman, as reported, insisted that his family had no history of eye defects as claimed by his employer’s attorneys. If he had disclosed any such ailment, if any, or the employer had an exclusion clause as the case may be, it would have been a different story.
It is safe to say that generally, an employer owes a duty of safety to the employee. The employer is to provide adequate materials, proper system and safe premises for work.
Where an employee is injured as a result of breach of any of these statutory duties, a claim may be brought against the employer for breach of statutory duty, care and compensation for injuries or disabilities suffered such as in the case of Suleiman.