The second last post in our ethics series is written by Jaimie Andrews, as she helps us to understand what client confidentiality really means. Thank you Jaimie!
Unpacking Client Confidentiality
The contents of the HPCSA’s Ethical Booklets Five and Nine have become the talk of the town since POPI and PAIA arrived on the scene (cue dramatic music). This is because these Booklets are all about protecting our clients’ confidentiality and POPI and PAIA are all about that consent. More than ever before, we are all now acutely aware of the immense quantity and intense quality of information gathered from our patients, both initially and continually throughout the intervention process.
While our profession affords us the right to request certain information about those whom we assess and treat so as to better inform our methods and approaches, our profession also ensures that we are duty-bound to protect their information.
Think back to your childhood when a best friend would whisper a secret into your ear during school break with an emphatic“Sssshhh!”she was expecting confidentiality that may or may not have been respected. The difference is that your best friend could only say “Don’t tell anyone!”, but we have this very clear and well-researched document describing all the do’s and don’ts of confidentiality right at our fingertips.
“These guidelines on confidentiality are the result of extensive discussion and debate with professional and patient groups and the provisions of the National Health Act. They place new responsibilities on health care practitioners regarding the obtaining of consent for and keeping patients informed about the disclosure of information concerning them.”– HPCSA Ethics Booklet Five, pg 1 Ethics_Booklet.pdf (hpcsa.co.za)
With national news and worldwide updates constantly changing the parameters of people’s physical movement and travel; the global pandemic and its resulting lockdowns provide us with an apt analogy for this topic. The flow of individuals allowed or not allowed to come and go within and beyond certain areas is similar to the flow of our patients’ information shared with us in the strictest confidence on intake and throughout treatment.
Imagine that you’re traveling somewhere – anywhere! It can be to a much-needed holiday away, a brilliant business trip, wherever. Now, imagine your luggage and its chartered course alongside yours from origin to destination. The items inside are personal to you, private even. You, therefore, keep your luggage with you at all times to make sure that only you can access its precious contents. But now, the baggage handler comes to stow your luggage clear of passageway traffic, fellow passengers, etc. You want to know that the baggage handler has neither pried nor removed anything from inside your luggage and you can check this at anytime, as you have control over that piece of luggage. You need to know. You have the right to know. The luggage and its contents are yours and yours alone – not to be shared with anyone.
Now, compare this with the luggage which we check into an aeroplane’s cargo hold. We see it go and only return on our arrival at the end of our journey. Sometimes, it’s pulled off the airport carousel fully intact as you last saw it. Other times – not so much. We have no idea how it came back to us: the route it followed, the people who handled it, the other bags it travelled with, etc. We would never pack our personal documents (ID, driver’s licence, passport, bank cards, etc.) in this luggage. We want to know where such important information is at all times. We need to know. We have the right to know. Those documents and the information which they contain are the property of owner and the owner’s alone. Just like the private / confidential information that our clients share with us. So! Let’s unpack this…
Clients bring us into their inner circle of trust by sharing their personal information, as well as and especially that of their children on their behalf. We health professionals are both ethically and legally responsible for protecting that information at every stage of our being privy to it: initial recording, storing, safe-keeping, moving, accessing, editing, sharing with the patients, etc. via intake documents, assessment forms, e-mail threads, treatment notes, WhatsApp messages and voice notes, online and in-person meetings, etc. This, we always knew (more or less). Now, our clients have the right to know too and we need to tell them.
They need to know when we are working directly with the information which we acquired from them. They also need to know what information and how, where, why and with whomever else, this information is shared, including but not limited to administrative and maintenance staff such as receptionists, accountants, students, job-shadowing learners, health and other professional colleagues such as teachers and other educational staff.
We all know the benefit of consistent open communication amongst all members of the multidisciplinary team, including the parents and child being treated. We also know, however, the great harm potentially and previously caused when information is shared without the child or parents’ consent, even amongst colleagues also treating and/ or teaching the child. Nevertheless, this does not mean that we only have these two extreme options available to us. We do not all need to keep our luggage tightly shut and locked away from one another in order to honour our clients’ confidentiality, nor do we need to communicate in secrets like when we were just kids.
Confidentiality is like promising to keep your friend’s secret or your luggage’s travel ticket safe ensuring that it follows you safely along your journey. Consent is like asking your friend if you can share her/his secret with a trustworthy adult to help your friend in some way. Without consent, it is safer to err on the side of caution, i.e. “If in doubt, don’t…”
In a school setting maintaining confidentiality and ensuring that therapists have informed consent is of the utmost importance. Therapists may not discuss a child or share information pertaining to a child with any other team member unless they have explicit permission (consent) from the child’s parent / legal guardian.
If you strongly believe that sharing some specific piece of information will add value to your clients’ development then keep trying to get consent – don’t be tempted to breach confidentiality! Go back and check in with your clients: both the child and her/ his parents. Advocate for the likely benefit of sharing the specific information you recommend they do and with whom, as well as when, where and how.
The benefit is the why and we all know how much children love that question. So, let’s take inspiration from them! When you are wanting to share some information about a client, always ask yourself – why? e.g. Why is it necessary or beneficial to share that specific information, with that person, in that way, at that time? If you answer is ethical and you feel good about it, then advocate on client’s behalf, but remember the final say in what information is shared, lies with your client.