Scenario Confidentiality & Privacy

You are grocery shopping and run into one of your former clients. The client is accompanied by their two children.  The client enthusiastically shares an update with you about her medical condition – she is pleased to report that she is doing much better physically and was recently discharged by her oncologist.  The client also reports that they are going through a job change and a separation from their spouse.  Is the information you received about the client confidential?

In the scenario, “Running into a client in a social setting”, the dietitian had the client’s knowledgeable consent to collect the client’s personal information for the provision of healthcare, not for any other purpose.  Entertaining the notion that certain client information is confidential and that other client information may not be, could lead to inadvertent disclosure. Therefore, all client information obtained through a professional relationship should be considered confidential; authority to disclose it— in writing, in speaking, in emails, or any other form — must be acquired from somewhere. Consent is always needed to disclose information in any form, with some exceptions.

Without confidentiality, clients will not be forthcoming or trust their health care providers with the very private and personal information necessary for their care.

A dietitian should consider first that all medical and non-medical information provided by a client is confidential, even if it was obtained in an informal conversation. In this case, the client revealed information about themselves at an informal encounter.  This information should be considered confidential, despite the setting. Even the fact that a person is your client is confidential. When speaking with a client outside of a professional setting, a dietitian must be aware that the client might consider the conversation as being covered by the duty of confidentiality, even though it is not a professional encounter. In that context, the dietitian should be sure that the client consents prior to disclosing any information, or that there is some other legal authority before disclosing any information.

Revealing confidential information about a client is viewed as unethical and professional misconduct, and could result in a lawsuit for damages. The definition of professional misconduct that requires confidentiality is worded as follows in the Professional Misconduct Regulation:

“12. Giving information about a client to a person other than the client or his or her authorized representative, except with the consent of the client or his or her authorized representative or as required or allowed by law.”

In addition to the misconduct definition under the Dietetics Act, 1991 some statutes have specific provisions dealing with confidentiality. For example, the Public Hospitals Act, 1990 has rules as to when client information can be revealed externally. Similarly, for dietitians who work for a government body, the Freedom of Information and Protection of Privacy Act, 1990 and the Municipal Freedom of Information and Protection of Privacy Act, 1990 might apply. The Mental Health Act, 1990 covers dietitians working in a mental health facility.