Is there a risk of a trade-off developing between patient trust and going virtual?
Confidentiality is a key principle of medical ethics and utterly drummed into all medical students from the outset. According to the British Medical Association, "Confidentiality is central to the development of trust between doctors and patients. Patients must be able to expect that information about their health is kept confidential unless there is a compelling reason that it should not be. There is also a strong public interest in confidentiality as individuals who need treatment will be encouraged to seek treatment and to disclose information that is relevant to it". In other words, confidentiality underpins trust between the doctor and patient.
Burning money, confidentiality and ambition
It is therefore somewhat disturbing when news of major patient information leaks emerge - as reported in The Times and Sunday Times. According to the report, a patient logged into an App provided by the government lauded digital health company, Babylon, only to discover that he also had access to the health records of other patients.
The Babylon business model aims to replace NHS GPs with a far cheaper automated and remote system. There is therefore a major financial incentive with stratospheric potential rewards, especially for the former Golman Sachs banker, Ali Parsa who runs the company. Burning confidentiality is probably one of the most obvious threats to this form of digital business, and so it is perhaps surprising that the appropriate safeguards were not in place.
There is a current backdrop of a burgeoning 'virtual consultation' market, demand for which has been accelerated by pandemic lockdown. Along with the emergence of dozens of new digital healthcare companies entering the fray, the lack of resilience in maintaining trust is a disaster for the sector. Trust is naturally fundamental to the professional - patient partnership. Providing appropriate care, let alone best care is not possible without trust. As is being generally reported following this incident, all patients have to give serious thought prior to sharing information online now, and this is a major set back for the movement toward digital healthcare. The concern over confidentiality using these systems has always been there, but now that concern has been totally warranted. As The Sunday Times feature piece says, quoting the head of healthcare at Silicon Valley Bank, Nooman Haque, "Technologies related to health need to have the resilience of nuclear - and you can't have accidents in nuclear".
Patient confidentiality must come first
Despite major commercial pressures, patient confidentiality must always come first. This is obvious and it goes without saying. However, sometimes the obvious evidently needs re-stating - three times if necessary.
As reported by our own doctors at Total Health, it is our experience as a medical publishing website that although we ask patients not to add any personal information to doctor referral request forms, it often will get added. The temptation or need to do so is sometimes too great, and this is understandable as it is only natural to want to provide as much useful information as is possible. So, despite having the security in place, in the interests of patient confidentiality TotalHealth decided some years ago to remove the ability to add personal medical information at this initial point of contact. Patient confidentiality, confidentiality, confidentiality must always come first, second and third.