Medical confidentiality and information sharing: practical guide

Medical confidentiality is not an obligation of discretion: it is a prohibition, backed by criminal sanction, that applies to every professional working within the healthcare system. Its distinguishing feature is that it admits no exception based on good intentions. What authorizes information sharing is never the usefulness of that sharing, but a text that has expressly provided for it.

What the duty of confidentiality covers

The duty of confidentiality covers everything that has come to the professional's knowledge in the course of their duties: not only what was confided to them, but also what they saw, 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 from the patient.

It applies to all professionals working within 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, subject to criminal sanction. 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 widely 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, which requires shared 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 This consent may be withdrawn at any time.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 strictly necessary for coordinating or continuing care may be shared, within the scope of each person's duties. A professional does not get access to the entire record simply because they belong to the team: they get access 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 upon request, with a response time 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 record so long as the patient is conscious and capable.

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 patient's cohabiting partner or civil partner may obtain the information necessary to understand the causes 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 information corresponding to that reason is disclosed.

Statutory exceptions

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

The guiding principle remains the same: an exception arises from a legal text, never from a discretionary judgment of usefulness. A professional convinced that a disclosure would be helpful is not thereby authorized to make it.

The technical dimension of confidentiality

Confidentiality is not simply about not talking. It requires concrete measures to protect records, and the absence of such measures is in itself open to criticism.

Health data hosted by a third party must be hosted with a host holding the certification required for that purpose. Exchanges between professionals require secure healthcare messaging systems rather than consumer messaging apps. And access to records must be logged, so that it can be established who consulted 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 never took place. This is the same evidentiary logic that applies to obtaining consent: what is not logged can be neither 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 is a one-off opinion outside of that 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 alone decides whether to forward it.

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

Frequently asked questions

Does confidentiality end when the patient dies? No. It continues, subject to narrowly defined exceptions for heirs, the cohabiting partner or civil partner, for specific and strictly limited reasons.

Can information be exchanged freely 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 is not enough.

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 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 app 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 authorize what 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, that between the care team, where sharing is presumed with the patient retaining a right to object, and the outside world, where prior consent is required. Second, the cross-cutting distinction between access to a record and access to the information necessary for a given task — the latter being the only kind ever authorized. The traceability of access is not a secondary constraint: it is what makes it possible to demonstrate, years later, that this limit was respected.