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Right to information and patients secrets


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Right to information and patients' secrets

as reported by Dr C Jayan | 01 Oct 2008 in Express Buzz


Recently, under some strange quirk of fate, the writer had to assume

charge as Public Information Officer of Medical College Hospital,

Trivandrum. This has been a totally unexpected betrothal on me who at

times had dreamt about becoming a pilot, an astronaut, an engine

driver, a candy-man and a surgeon.


But this is something that comes free with the headship of a public

office nowadays in India and government hospitals are no exception.

The basis of what follows is the experience gained while judging the

thin line that separates the domains of confidentiality of personal

medical data and the right of a citizen to know about the activities

of a public authority.


It is in some ways poetic justice that the Right to Information Act

should finally come into being in India which has one of the oldest

known organised methods of sequestrating knowledge to select sections

of the society. The practice of not allowing 'sudras' & 'vaisyas' to

learn Veda is proof enough that we knew information is power right

from the beginnings of our civilisation! The first attempt to allow

free access to information held in government custody came in the form

of the Freedom of Information Act in 2002. RTI Act 2005 is a further

refinement of this Act.


The preamble of the RTI Act acknowledges the existence of conflicting

interests of need for secrecy and an informed citizenry for the proper

functioning of democracy. It aims to harmonise these conflicting

interests while preserving the paramountcy of democracy. It is meant

to contain corruption and to hold the government accountable for the



A law can only be as good as the society which uses it. RTI Act, meant

for 'promoting transparency and accountability in the working of

public authority' is most commonly used in our hospital for obtaining

case sheets, wound certificates and postmortem reports by advocates to

expedite settlement of their cases in MACT. In their eagerness to

settle cases they perhaps forget the fact that information gathered

while practising medicine is considered sacred and doctors are sworn

to protect it. The Medical Council of India stipulates that a

registered medical practitioner shall not disclose the secrets of a

patient that have been learnt in the exercise of his profession except

in a court of law under orders of the presiding judge. This assurance

of secrecy is an essential prerequisite for seamless doctor-patient

relationship and the facts revealed when there is such confidence may

even contribute to correct diagnosis. Violation of code of medical

ethics can risk erasure of the name of the practitioner from the



It is also not entirely unimaginable that one of these days someone

will request the case sheets of his neighbour with whom he has a score

to settle. If it states that he is HIV positive and if this fellow

takes the photocopy and circulates it in the community leading to the

suicide of this person, who will be responsible? The fear of

discrimination and ostracism on revelation of disease status prevails

to different degree in different cultures, for different diseases and

at different periods in history.


There are other situations in which a patient may desire absolute

secrecy, sometimes even from the spouse. Once I had a patient who

preferred marrying off his daughter to chemotherapy for himself. This

intelligent man understood that the best deal he could get from

chemotherapy is perhaps 6 more months but the cost of it would wreck

the plans of marriage. He feared that if the relatives knew this they

would compel him to have chemotherapy and wanted to retain his dignity

by making correct decision for his family in those last months of his

life. I complied with his request of not disclosing his disease to his

family for which even one day of extension of his life was more



Imagine if one of his relative files an application under RTI Act?!

Doctor's consultation rooms abound with hundreds of such instances. On

the other hand there are instances when public access to the medical

records is desirable.


Before arranging a marriage, if the medical records are accessible to

the prospective life partner marriage with an HIV positive person can

be prevented.


The grounds for rejection of an application for the medical records of

a third person need to be stated just as explicitly as in the case of

Jammu & Kashmir.


Provisions should be built into the Act which will discourage citizens

from using this boon for ensuring accountability of government just as

a shortcut to expedite personal pursuits which are of no public

interest whatsoever.


The writer is Deputy Superintendent, Medical College Hospital, Trivandrum.




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