Medical confidentiality and information sharing: practical guide

Medical confidentiality is not a duty of discretion: it is a prohibition, backed by criminal sanctions, that applies to every professional working within the healthcare system. Its distinctive feature is that it admits no exception based on good intentions. What authorises information sharing is never the usefulness of that sharing, but a provision that has expressly allowed for it.

What confidentiality covers

Confidentiality covers everything that has come to the professional's knowledge in the course of their duties: not only what has been confided to them, but also what they have seen, heard or understood. This extension is decisive — information revealed by a third party, or inferred from an observation, falls within scope just as much as a confidence shared by the patient.

It applies to all professionals working within the healthcare system, including administrative staff, trainees and outside contributors. It ends neither when care comes to an end, nor upon the patient's death.

A breach is a criminal offence, subject to criminal penalties. This is compounded by disciplinary consequences before professional bodies and, where applicable, civil liability, which falls within the scope of professional civil liability.

Sharing between professionals: two distinct regimes

This is the most misunderstood point, because the rule differs depending on the composition of the team.

Within a single care team, information may be shared between professionals without obtaining specific consent. The patient is deemed to have been informed and may object. A care team is a defined legal concept, requiring shared responsibility for care: professionals from the same institution, or contributors whom the patient has themselves designated as taking part in their care.

Outside the care team, sharing requires the patient's prior consent, obtained by any means, including electronic means. This consent may be withdrawn at any time.

In both cases, a common limit applies, and it is often overlooked: only information that is strictly necessary for the coordination or continuity of care may be shared, within the scope of each person's duties. A professional does not have access to the entire record simply because they belong to the team: they have access to what their role requires.

The patient, their relatives and the trusted person

The patient has a direct right of access to all information concerning their health. This right is exercised on request, with a response time that varies depending on how old the information is.

The trusted person, appointed in writing, accompanies the patient and receives information when the patient is unable to express their wishes. Their appointment does not grant them a general right of access to the record for as long as the patient is conscious and capable.

The patient's relatives may receive the information necessary to support the patient in the event of a serious diagnosis or prognosis, unless the patient objects. Here too, the scope is limited to what that support requires.

After death, heirs, the patient's cohabiting partner or civil partner may obtain the information necessary to establish the cause of death, defend the memory of the deceased or assert their rights — unless the patient expressed an objection during their lifetime. The reason must be specified, and only the information corresponding to that reason is disclosed.

Statutory exceptions

Certain disclosures are permitted, or even required, by specific provisions: mandatory notification of certain diseases, reporting of abuse or neglect of minors and vulnerable persons, responses to certain judicial requisitions, and communication to the medical adviser as part of medical review.

The guiding principle remains the same: an exception derives from a legal provision, never from a judgement of expediency. A professional who is convinced that a disclosure would be useful is not thereby authorised to make it.

The technical dimension of confidentiality

Confidentiality is not limited to refraining from speaking. It requires concrete measures to protect the media on which information is held, and the absence of such measures is in itself open to criticism.

Health data hosted by a third party must be hosted with a provider holding the certification required for that purpose. Exchanges between professionals require secure healthcare messaging systems rather than consumer messaging services. And access to records must be logged, so that it is possible to establish who accessed what and when — a requirement covered in detail in our article on the electronic medical record.

This traceability serves a dual purpose: it prevents unauthorised access and it protects the professional, by making it possible to demonstrate that an alleged access did not in fact take place. This is the same evidentiary reasoning that applies to obtaining consent: what is not logged can neither be proven nor disproven.

Usage scenarios

Referral to a colleague. If the colleague takes part in the patient's care, the sharing falls within the care team and does not require specific consent. If it involves a one-off opinion outside the course of care, the patient's consent is required.

Request from an employer or insurer. No information may be disclosed to them. The professional hands the document to the patient, who decides whether to pass it on.

Group practice. Belonging to the same organisation does not automatically create a care team for a given patient. The criterion is actual participation in the patient's care, which requires differentiated access permissions, a subject covered in our article on administrative compliance for a medical practice.

Frequently asked questions

Does confidentiality end upon the patient's death? No. It continues, with strictly defined exceptions for the benefit of heirs, the cohabiting partner or civil partner, for precise and narrowly permitted reasons.

Can information be freely exchanged within an institution? Only between professionals actually taking part in the patient's care, and only for information necessary to that care. Belonging to the institution is not sufficient.

Can the patient object to sharing? Yes. Within the care team, they may object to sharing once they have been informed. Outside it, their prior consent is required and may be withdrawn at any time.

Can a professional respond to a requisition? It depends on the legal basis of the requisition. Some create an obligation to respond, others do not. The professional must verify the legal basis before disclosing anything and limit their response to its purpose.

Is an ordinary messaging service sufficient between practitioners? No. Exchanges of health data require dedicated secure messaging systems; using a consumer messaging service is in itself a breach of the required protective measures.

Can relatives be informed? In the event of a serious diagnosis or prognosis, and unless the patient objects, for information necessary to support them. The scope remains limited to that purpose.

Key takeaways

Medical confidentiality stands out for its inverted logic: it does not permit whatever is useful, it prohibits everything except what a provision has expressly allowed for. A professional faced with a request for disclosure must therefore look for the legal basis, never the practical justification.

Two distinctions govern most situations. The first is between the care team, where sharing is presumed with a right for the patient to object, and the outside, where prior consent is required. The second, which cuts across the first, is between access to a record and access to information necessary for a given task — the latter being the only one that is ever permitted. Logging access is not a secondary constraint: it is what makes it possible to demonstrate, years later, that this limit has been respected.