Right to information and patients secrets

[sidmis]

Right to information and patients' secrets
as reported by Dr C Jayan | 01 Oct 2008 in Express Buzz

Recently, under some strange quirk of fate, the writer had to assume
charge as Public Information Officer of Medical College Hospital,
Trivandrum. This has been a totally unexpected betrothal on me who at
times had dreamt about becoming a pilot, an astronaut, an engine
driver, a candy-man and a surgeon.

But this is something that comes free with the headship of a public
office nowadays in India and government hospitals are no exception.
The basis of what follows is the experience gained while judging the
thin line that separates the domains of confidentiality of personal
medical data and the right of a citizen to know about the activities
of a public authority.

It is in some ways poetic justice that the Right to Information Act
should finally come into being in India which has one of the oldest
known organised methods of sequestrating knowledge to select sections
of the society. The practice of not allowing 'sudras' & 'vaisyas' to
learn Veda is proof enough that we knew information is power right
from the beginnings of our civilisation! The first attempt to allow
free access to information held in government custody came in the form
of the Freedom of Information Act in 2002. RTI Act 2005 is a further
refinement of this Act.

The preamble of the RTI Act acknowledges the existence of conflicting
interests of need for secrecy and an informed citizenry for the proper
functioning of democracy. It aims to harmonise these conflicting
interests while preserving the paramountcy of democracy. It is meant
to contain corruption and to hold the government accountable for the
governed.

A law can only be as good as the society which uses it. RTI Act, meant
for 'promoting transparency and accountability in the working of
public authority' is most commonly used in our hospital for obtaining
case sheets, wound certificates and postmortem reports by advocates to
expedite settlement of their cases in MACT. In their eagerness to
settle cases they perhaps forget the fact that information gathered
while practising medicine is considered sacred and doctors are sworn
to protect it. The Medical Council of India stipulates that a
registered medical practitioner shall not disclose the secrets of a
patient that have been learnt in the exercise of his profession except
in a court of law under orders of the presiding judge. This assurance
of secrecy is an essential prerequisite for seamless doctor-patient
relationship and the facts revealed when there is such confidence may
even contribute to correct diagnosis. Violation of code of medical
ethics can risk erasure of the name of the practitioner from the
register.

It is also not entirely unimaginable that one of these days someone
will request the case sheets of his neighbour with whom he has a score
to settle. If it states that he is HIV positive and if this fellow
takes the photocopy and circulates it in the community leading to the
suicide of this person, who will be responsible? The fear of
discrimination and ostracism on revelation of disease status prevails
to different degree in different cultures, for different diseases and
at different periods in history.

There are other situations in which a patient may desire absolute
secrecy, sometimes even from the spouse. Once I had a patient who
preferred marrying off his daughter to chemotherapy for himself. This
intelligent man understood that the best deal he could get from
chemotherapy is perhaps 6 more months but the cost of it would wreck
the plans of marriage. He feared that if the relatives knew this they
would compel him to have chemotherapy and wanted to retain his dignity
by making correct decision for his family in those last months of his
life. I complied with his request of not disclosing his disease to his
family for which even one day of extension of his life was more
desirable.

Imagine if one of his relative files an application under RTI Act?!
Doctor's consultation rooms abound with hundreds of such instances. On
the other hand there are instances when public access to the medical
records is desirable.

Before arranging a marriage, if the medical records are accessible to
the prospective life partner marriage with an HIV positive person can
be prevented.

The grounds for rejection of an application for the medical records of
a third person need to be stated just as explicitly as in the case of
Jammu & Kashmir.

Provisions should be built into the Act which will discourage citizens
from using this boon for ensuring accountability of government just as
a shortcut to expedite personal pursuits which are of no public
interest whatsoever.

The writer is Deputy Superintendent, Medical College Hospital, Trivandrum.


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