Medical Confidentiality and Information Sharing: Practical Guide

Medical confidentiality is not a mere obligation of discretion: it is a prohibition, backed by criminal sanctions, that applies to every professional involved in the healthcare system. Its distinctive feature is that it recognises no exception based on good intentions. What authorises a sharing of information is never the usefulness of that sharing, but a text that has expressly provided for it.

What confidentiality covers

Confidentiality covers everything that has come to the professional's knowledge in the course of carrying out 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 involved in the healthcare system, including administrative staff, trainees and outside contributors. It does not end either with the conclusion of care or with the patient's death.

A breach is a criminal offence, punishable accordingly. On top of this come 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 point most commonly misunderstood, because the rule differs depending on the composition of the team.

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

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 This consent may be withdrawn at any time.

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

The patient, their relatives and the trusted support person

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

The trusted support person, designated in writing, accompanies the patient and receives information when the patient is unable to express their wishes. Their designation does not grant them a general right of access to the file so long as the patient remains 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 such support requires.

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

Legal exceptions

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

The guiding principle remains the same: the exception derives from a legal text, never from a judgment of convenience. A professional 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 records, and their absence is in itself open to criticism.

Health data hosted by a third party must be hosted with a host holding the certification provided for that purpose. Exchanges between professionals require secure health-messaging systems rather than consumer messaging applications. And access to the file must be logged, so that it is possible to establish who accessed what and when — a requirement detailed in our article on the electronic medical record.

This traceability serves a dual purpose: it prevents improper 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 of consent: what is not logged can neither be proven nor disproven.

Usage scenarios

Referral to a colleague. If the colleague is involved in the patient's care, the sharing falls within the care team and requires no specific consent. If it involves a one-off opinion outside the scope of care, the patient's consent is required.

Request from an employer or an insurer. No information may be disclosed to them. The professional hands the document to the patient, who alone 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 involvement in the patient's care, which requires differentiated access permissions — a subject addressed in our article on administrative compliance for a medical practice.

Frequently asked questions

Does confidentiality end on the patient's death? No. It continues, subject to strictly defined exceptions in favour of heirs, the surviving partner or the civil partner, for specific and exhaustively recognised reasons.

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

Can the patient object to sharing? Yes. Within the care team, they may object to sharing once informed of it. Outside the team, 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 must limit their response to its stated purpose.

Is an ordinary messaging app sufficient between practitioners? No. Exchanges of health data require dedicated secure messaging systems; using a consumer messaging application is in itself a failure to meet protective requirements.

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 legal text has expressly provided 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. First, between the care team, where sharing is presumed subject to the patient's right to object, and the outside world, where prior consent is required. Second, a cross-cutting distinction between access to a file and access to the information necessary for a given task — only the latter ever being authorised. Traceability of access is not a secondary constraint: it is what makes it possible to demonstrate, years later, that this limit was respected.