I’m not sure of the health privacy laws in other countries, but in New Zealand there are a couple of pieces of law that govern access to health information.
I can readily understand that it’s not OK to release health information willy-nilly to all-comers (even case managers involved in rehabilitation!).
BUT I do have a problem with a situation that occurs almost every day in pain management.
Imagine if you will that a patient is referred to see you. You talk to him (for ease of writing today, I’m using the word ‘he’) about his pain, and as a team, you and your colleagues decide on a course of action that includes medication as well as reactivation and developing self management skills. Doesn’t sound too scary just yet, does it?
Well, imagine if that person was at the same time engaged with another service (within your own facility), but you are
(a) not allowed to access the clinical records from that service
(b) the person doesn’t tell you that he’s involved with that service
(c) that service isn’t allowed to contact you with that information without the consent of that person
– and (d) that person is being prescribed another medication that could interact with what he’s been prescribed by your service, and
(e) he has been recently admitted for a serious attempt at self-harm and the service he’s seeing (within your own facility) is continuing to work with him around this attempt.
Hmmm, the picture gets complicated doesn’t it?
The problem with selective disclosure of health information (ie picking and choosing the information that is disclosed) is that some very important, potentially harmful situations can be completely missed in the name of ‘health information privacy’. And in this situation, information from most other health services within this facility can be, and is, accessible.
With one exception: mental health information.
Now I can’t think of a more potentially hazardous area NOT to know about than a person’s mental health when they are attending a pain management service.
Pain affects every part of a person’s being, and especially when it’s chronic pain, and especially when it’s intractable, people are stressed – often stressed to the point where any vulnerability in their mental health can start to be revealed. Managing mental health problems involves using many of the same medications that are used in chronic pain management. Mental health problems often lead to high risk of serious self harm. Chronic pain can lead people to serious depression and anxiety states – with thoughts of self harm, and even attempts.
After all the work that has gone into normalising mental health problems as being no more shameful than breaking a leg or having bronchitis, I cannot see why mental health information is more protected than, for example, cardiac or respiratory health information. Yet, according to the Health and Disability Commission in New Zealand, access to mental health information cannot be given even to people directly involved in the person’s health care within the same facility, even when the potential consequences of NOT having access could be fatal.
The thought seems to be that a reasonable person asking for health care would be quite prepared to disclose mental health information to us, so we should ask their permission for access to their records and the person will give it to us. Quite reasonable, yes?
But why is mental health information any different from other health information?
And what happens if the person attending isn’t ‘reasonable’ – for example, is drug-seeking, is planning serious self-harm, has a personality disorder that means they are prone to unusual beliefs and actions?
And what happens if we, as health providers, inadvertently place that person into a high risk situation by prescribing something that they haven’t chosen to disclose to us? Or something they’ve tried before but had a bad reaction to? Or we try something they’ve had before but didn’t work effectively? Or we give them something they’re already getting with a mental health service? (eg CBT)
Along with the right to privacy is the responsibility to adequately disclose information. Sometimes people are completely unaware of the need to tell us something, sometimes they choose not to tell us something, sometimes they deliberately mislead us. Just as it’s important to know about someone’s cardiac status before we begin reactivation, we also need to know about a history of self harm or delusional behaviour or serious depression.
Who is being protected by selective disclosure of health information? Is it really in the patient’s best interests? Is it in the best interests of the community? Is it in the best interests of the health care provider? And again, why is mental health information dealt with differently from other health care information?