When does medical confidentiality become unjustified secrecy?

This blog by CHF CEO Adam Stankevicius was originally published as part of  the  ‘When does medical confidentiality become unjustified secrecy?’ piece on Croakey.
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Claims of medical confidentiality have spawned a disturbing trend towards unjustified and unacceptable secrecy.

The tendency of the medical profession to avoid disclosing information that may be in their patient’s or the public’s interest, has been highlighted with the recent release of Medicine Australia’s (MA) proposed code of conduct.

MA has just published its proposed code of conduct as part of its attempt to gain the authorisation of the Australian Competition and Consumer Commission (ACCC)

Despite the ACCC’s earlier direction for the new code to require the naming of clinicians who have received payments and other perks from drug companies, MA’s proposed code has stopped short of this measure.

While it has been suggested that there are technical impediments to keeping track of 40-odd drug companies’ payments to medical practitioners, apparently a significant factor was resistance from the medical profession itself.

There is a small number of doctors who have championed stronger transparency measures, but the idea of revealing drug company payments and gifts to clinicians failed to inspire revelations from the medico mainstream.

We hope it goes without saying that most doctors are unlikely knowingly to modify either their own prescribing behaviour or advice to colleagues on the basis of emoluments from drug companies.

However there is enough evidence from here and overseas to demonstrate that in some cases doctors do modify their behaviour in response to industry inducements.

The wider point is that patients and consumers, whose lives and health may depend on the doctor’s treatment choices, have a reasonable expectation of being able to discover which companies distributing the drugs they are prescribed are paying their prescribing doctor.

Confidentiality now seems to be claimed as much to protect the doctor’s interests as the patient’s wellbeing. Often the doctor’s privacy may work against the patient’s interests. For instance attempts have been made by health funds and others to publish details about doctors charging practices. These have sunk in the face of determined resistance from doctors groups like the Australian Medical Association (AMA) on privacy grounds.

Ditto any steps towards tracking performance and outcomes of individual surgeons.

Medicare Australia and the Pharmaceutical Benefits Scheme hold a vast trove of information that, particularly when linked, could tell us much more quickly and accurately about cost effectiveness of different treatments and the likely costs to consumers.

As former Health Department Secretary Stephen Duckett has said, the combination of existing federal and state government data could tell us much more about the costs and performance of individual doctors.

The federal health authorities have resisted repeated pleas from researchers for easier access to these data. Again the shroud of privacy is deployed. Perhaps in this instance privacy is cited more to shelter officialdom than doctors, but the claim to privacy is made easier because of the camouflage of medical confidentiality.

Such an explanation is risible given the data can be easily de-identified and apply in most cases to many thousands of individual patients.

The paradox is that in a calling that is meant to be evidence-based, the medical profession has failed to press for the effective use of this information.

In a data-rich world, the practice of medicine is caught in an anachronism, applying the shibboleth of confidentiality in ways that do the patient, consumer and themselves no good.

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About the author

Adam Stankevicius

Adam Stankevicius was Chief Executive Officer of the Consumers Health Forum of Australia.