Modules

Consent and confidentiality

Introduction

The Communication and Cultural Competence program is based on case studies that give examples of everyday medical practice in Canada. These modules do not focus on diagnosis and treatment. Instead, they focus on communication between health professionals and patients. Please note that the modules are not intended to show the only way to deal with a situation. Instead, they are intended to provide guidance on how to approach and reflect on these different scenarios.
  • Case 1 occurs in a family physician’s office. It starts with a seemingly simple and happy visit to the physician, but as you will see it turns into something quite different. The case is divided into sections, each with associated exercises and readings. As you work through the case, you will see four types of interactive material.

    The “Knowledge checks” throughout the website are organized as multiple-choice quizzes, which are simply intended to give you an idea of the kind of basic knowledge the physician might need to deal with the various situations.

    The “Reflective exercises” should encourage you to think about communication as well as ethical and professional behaviours. While you are asked to make clinical decisions by choosing from various options, don’t be surprised if you find that there is not one right answer. That is often what happens in real-life situations. All of the options and the commentaries on the options should be studied.

    MCC role objectives and sentinel habits are provided in each case. While the wording may seem vague, try to determine how the role objectives and sentinel habits relate to the case. What may seem like a simple comment from the physician or patient can be an important point. Also, think about your own experiences as a physician. Can you remember incidents from your practice that also relate to these objectives and sentinel habits?

    Finally, there are some readings from the literature at the end of each case that you might find helpful.

MCC role objectives

Communicator

  • When appropriate, facilitate collaboration among families and patients, while maintaining patient wishes as the priority, ensuring confidentiality, and respecting patient autonomy (1.5)
  • Effectively communicate in challenging situations (delivering bad news, addressing anger, confusion, medical error, misunderstanding and media interviews) (3.5)
  • Disclose to the patient personal values or beliefs that may limit professional involvement (3.7)

 

Collaborator

  • Recognize that the clinical situation requires expertise beyond one’s own, and determine the urgency (2.2)

 

Professional

  • Maintain patient confidentiality (2.3)
  • Know and communicate to patients the limits of professional confidentiality (reportable conditions, duty to warn) (2.3.2)
  • Know, and appropriately implement, current ethical and legal aspects of the consent and capacity process (2.4) These include:
    • principles of full disclosure (2.4.5)

 

Health advocate

  • Assess and respond to the specific determinants of health relevant to the individual, the community, and/or the population (1.1)
  • Know and understand the key issues in the Canadian health system and any relevant laws and legislation (3.0)

Sentinel habits

  • Manages patients using available best practices (2)
  • Verbal or written communication is clear and timely (9)

Entrustable professional activities

  • Assess, diagnose and manage patients with acute, common and complex diseases across outpatient settings (2)
  • Collaborate with patients, families and members of the interdisciplinary team (9)

 

Critical competencies

  • Seeks appropriate consultation from other health professionals, recognizing the limits of one’s own expertise (5)
  • Develops rapport, trust and ethical therapeutic relationships with patients and families (8)
  • Accurately elicits and synthesizes relevant information and perspectives of patients and families, colleagues and other professionals accurately (9)
  • Conveys relevant information and explanations accurately to patients and families, colleagues and other professionals (10)
  • Demonstrates a commitment to their patients, profession and society through ethical practice (19)
  • Demonstrates knowledge of and applies the professional, legal and ethical codes for physicians (21)

Objectives

By the end of this module the participants should be able to:

  • Demonstrate an understanding of the fundamental values underlying the consent and confidentiality process in Canada (such as autonomy and respect for persons)
  • Demonstrate an ability to apply Canadian standards of consent and confidentiality in clinical situations, using appropriate communication skills
  • Demonstrate an ability to act appropriately and professionally when individual patient and societal claims are in conflict

Self-assessment quiz

  1. What are the three components required in obtaining consent to treatment?
  2. What are the exceptions to the rule of confidentiality?
  3. How does one resolve a conflict between duty to patient and duty to society?
  4. What are the public-health requirements concerning reportable diseases?

 

Next: Part 1

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