Something Greater than Confidentiality

The value of confidentiality is of extreme importance to all physicians and, as a result, the entirety of the healthcare industry. In fact, the legal concept of confidentiality is said to have been translated from within the Hippocratic Oath as detailed in the statement “Whatsoever I see or hear within the course of my practice, or outside my practice in social intercourse, that ought never be published abroad, I will not divulge, but consider such things to be holy secrets” (Emson, 1998). From this basic ethical foundation, many different laws and types of legislation have been created for the sake of protecting the privacy of individual patients. This is especially important when considering that divulging such sensitive information could lead to dire consequences for the individual patient or the legally responsible party who thought it would be a good idea to share such information with others.

In general, throwing the proverbial "book" at those who either steal or willingly share sensitive information or documents about an individual patient under their direct or indirect care is justifiable. As a society, we continue to create many legal, electronic, and physical barriers to prevent this. However, what happens to individuals who mistakenly share information either through neglect or sheer stupidity? How are we as individual managers supposed to react? What type of punishment should be considered enough?

Before answering this question, any manager must weigh any of the potential consequences created by addressing this matter. In one hand, the manager must protect the integrity and reputation of the organization at all cost. No matter the individual, it is paramount that the organization's good name be maintained. On the other hand, what possible harm was accomplished? Was any information shared and if anyone can testify with 100% truth that not one bit information was shared or stolen with unwarranted individuals, should there be any repercussion? The answers to these questions are never simple. Like people, ethical situations are very unique and intricate. As a result, a manager must be willing and able to examine the situation and determine what should be the best course of action. However, no matter what type or types of disciplinary actions are taken its clear that mechanisms and protocols must be put into place to avoid a future manifestation of the same problem.

This all seems to be the rational and educated approach to this problem. Unfortunately such ethical problems are not always so easily solved. It should be noted that the vast majority of the time, sensitive patient information is breached not through premeditated decisions, but through sheer lack of professionalism. While many managers may share a sigh of relief, such problems are only small indicators of an even larger more significant situation that at one point will emerge in the future: poor quality. Quality is above all the most important product healthcare managers produce for their community and patients. Without this quality a healthcare organization fails to achieve the overall common goal of any healthcare organization: increasing the quality of human life.

Its possible that this may be an overzealous opinion and that small mistakes should not create create a situation where someone is "over-disciplined". Maybe a manager can even overlook these mistakes or just ignore them. However, when does a manager begin to discipline their staff? When does a problem become large enough to receive their attention? In the end, quality is something that does not happen overnight or by sheer luck, but rather through the combined effort of every individual within an organization. Though it is important to deal with such quality issues in a responsible manner, prevention is always the best medicine. If the problem was not prevented, then is this the fault of the individual or the manager? As stated, quality is everyone's responsibility and sometimes the fault does not lie with the person at fault.

References:
Emson, H. (1988). Confidentiality: A Modified Value. Journal of Medical Ethics, 14(2), 87-90.

75% of the Time I am Ethically Right all the Time

What is about ethics that tend to cause mass confusion, riots, and nuclear annihilation? When you consider that not one person I have asked today can provide me with a direct answer should begin to give you an understanding why this occurs: people fear what they do not understand. As a result of this misunderstanding, ethics can generally be defined as many different things to many different people. Often, ethics are confused with morality leading many highly educated professionals or "Joe six-packs" to make unethical decisions. Sometimes I find myself questioning what is ethics? I also tend to try and convince myself in true "Law and Order" style as to why something is ethical or unethical. This is never a very effective or efficient manner as talking to yourself is consider a faux pas by many of my co-workers. However, throughout these years I have come up with one simple understanding of ethics: ethics is the weak minded, timid brother of morality.

Morality is a robust and easy to understand "feeling". Often, morality tends to give us a clear direction as to where we are headed and how we are going to get there. Unfortunately, morality also tends to step on others' morality in it pursuit of global domination. In many ways morality means well, but like a bull in a china shop tends to destroy and fracture many items around it. Ethics, on the other hand, is the much more timid, scientific (if you will) brother of morality. Both are the offspring of social and cultural rules established through the hilarious trial and error process of our relatives. Both have been examined and re-examined by scholarly geniuses and the not so scholarly. However, ethics tends to take a much more scientific and worldly view of society and its actions as opposed to morality's local and finite understanding of the world around it. The constant quest of ethics isn't necessarily to be right, but rather to be fair.

So what exactly is ethics? For me, ethics is a way of combining the general aspects of morality, social norms, evidence based practices, the law, and common sense. Ethics is also a long term solution to a social dilemma. For many, ethics can be a painful decision to make, but it is usually the wise decision leading to successful longevity for both the individual or organization. However, as society evolves, ethics evolve. This means that professionals and organizations must be willing to invest both time and resources into continually evaluating, examining and, if needed, re-writing their own ethical backgrounds. This agreement is critical if ethics is to continue to evolve and our understanding to increase.

In summary, ethics is something that no one person or organization can define. On an organizational or individual level, ethics tend to vary greatly. However, ethics can be viewed as a combination of morality, social norms, evidence based practices, the law, and good ole' common sense. While we may never truly understand what it means to be ethical, we can agree that it is ever changing and evolving. At minimum, I know that I am 75% right all the time.